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BackgroundVariations in adjusted costs have been observed among trauma centres in the United States but patient outcomes were not better in centres with higher costs. Attempts to improve injury care efficiency are hampered by insufficient patient-level information on resource use and on the drivers of resource use intensity.ObjectivesTo estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use.MethodsWe conducted a retrospective cohort study including ≥16-year-olds admitted to adult trauma centres in a mature, inclusive Canadian trauma system between 2014 and 2016. We extracted data from the trauma registry and hospital financial reports. We estimated resource use with activity-based costs, identified determinants of resource use intensity using a multilevel linear model and assessed the relative importance of each determinant with Cohen's f2. We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals.ResultsWe included 32,411 patients. Median costs per admission were $4857 (Quartiles 1 and 3 2961-8448). The most important contributors to total resource use were the medical ward (57%), followed by the operating room (OR; 23%) and the intensive care unit (13%). The strongest determinant of resource use intensity was discharge destination (Cohen's f2 = 7%). The most resource intense patient group was spinal cord injuries with $11,193 (7115-17,606) per admission. While resource use increased with increasing age for the medical ward, it decreased with increasing age for the OR. Resource use was 18% higher in level I centres compared to level IV centres and we observed significant variations in resource use across centres (ICC = 5% [4-6]), particularly for the OR (28% [20-40]).ConclusionsResource use for acute injury care in Quebec is not solely due to the clinical status of patients. We identified determinants of resource use that can be used to establish evidence-based resource allocations and improve injury care efficiency. The method we developed for estimating patient-level, in-hospital resource use for injury admissions and identifying related determinants could be reproduced using local trauma registry data and our unit costs or unit costs specific to each setting.

Background: A better understanding of how chronic physical health conditions affect long-term outcomes following injury is essential for quantifying the burden of serious orthopaedic injuries. We aimed to describe the association between the presence of post-injury chronic physical health conditions and (i) the change in health status from before injury to six different follow-up time points after injury; and (ii) survival time. Methods: A cohort study was conducted using linked data from the REcovery after Serious Trauma: Outcomes, Resource Use, and Patient Experiences study, the Victorian Registry of Births, Deaths and Marriages (BDM) (2009–2017), the victorian admitted episodes dataset (2009–2017) and the victorian emergency minimum dataset (2009–2017). Adults (≥ 18 years old) with serious orthopaedic injuries who survived to discharge from their trauma admission were included. Multivariable linear regression analysis was conducted to evaluate the association between post-injury chronic physical health conditions and the mean change in health status (EuroQol-Visual Analogue Scale) from before injury to six follow-up time points post-injury. Survival analysis was conducted to estimate the probability of survival for people with and without chronic physical health conditions following injury. Results: Out of 894 participants, 177 (19.8%) had at least one chronic physical health condition recorded up to five years post-injury. People with post-injury conditions reported a greater mean decline in health status than people without post-injury conditions (difference, (95% CI): −6.9 (−9.7, −4.2), p = 0.01). Over the study period, almost six times as many people with chronic physical health conditions post-injury died as people without these conditions (AHR (95% CI): 5.7 (2.9, 11.3), p < 0.01). Conclusions: Chronic physical conditions after serious orthopaedic injuries were associated with a lower survival probability and a deteriorating health status. Orthopaedic injury survivors may benefit from early detection and treatment of chronic conditions. [ABSTRACT FROM AUTHOR]

Burn survivors can experience social participation challenges throughout their recovery. The aim of this study was to develop a novel Australian English translation of the Life Impact Burn Recovery Evaluation (LIBRE) Profile, the Aus-LIBRE Profile. This study consisted of 3 stages: (1) translation of the LIBRE Profile from American to Australian English by Australian researchers/burns clinicians, (2) piloting and cognitive evaluation of the Aus-LIBRE Profile with burn survivors to assess the clarity and consistency of the interpretation of each individual item, and (3) review of the Aus-LIBRE Profile by colleagues who identify as Aboriginal Australians for cross-cultural validation. In stage 2, investigators administered the translated questionnaire to 20 Australian patients with burn injuries in the outpatient clinic (10 patients from Victoria and 10 patients from Western Australia). Face validity of the Aus-LIBRE Profile was tested in 20 burns survivors (11 females) ranging from 21 to 74 years (median age 43 years). The total body surface area burned ranged from 1% to 50% (median 10%). Twelve language changes were made based on the feedback from the burn clinicians/researchers, study participants, and colleagues who identify as Aboriginal Australians. Using a formal translation process, the Aus-LIBRE Profile was adapted for use in the Australian burn population. The Aus-LIBRE Profile will require psychometric validation and testing in the Australian patient with burns population before broader application of the scale. [ABSTRACT FROM AUTHOR]

In North America, traumatic brain injury (TBI) is an important cause of mortality and disability for youth and older adults. (1,2) TBI is responsible for nearly half of all injury-related [...], Background: The knowledge gap regarding acute care resource use for patients with traumatic brain injury (TBI) impedes efforts to improve the efficiency and quality of the care of these patients. Our objective was to evaluate interhospital variation in resource use for patients with TBI, identify determinants of high resource use and assess the association between hospital resource use and clinical outcomes. Methods: We conducted a multicentre retrospective cohort study including patients aged 16 years and older admitted to the inclusive trauma system of Quebec following TBI, between 2013 and 2016. We estimated resource use using activity-based costs. Clinical outcomes included mortality, complications and unplanned hospital readmission. Interhospital variation was evaluated using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs). Correlations between hospital resource use and clinical outcomes were evaluated using correlation coefficients on weighted, risk-adjusted estimates with 95% CIs. Results: We included 6319 patients. We observed significant interhospital variation in resource use for patients discharged alive, which was not explained by patient case mix (ICC 0.052, 95% CI 0.043 to 0.061). Adjusted mean resource use for patients discharged to long-term care was more than twice that of patients discharged home. Hospitals with higher resource use tended to have a lower incidence of mortality (r -0.347, 95% CI -0.559 to -0.087) and unplanned readmission (r -0.249, 95% CI -0.481 to 0.020) but a higher incidence of complications (r 0.491, 95% CI 0.255 to 0.666). Conclusion: Resource use for TBI varies significantly among hospitals and may be associated with differences in mortality and morbidity. Negative associations with mortality and positive associations with complications should be interpreted with caution but suggest there may be a trade-off between adverse events and survival that should be evaluated further. Contexte : Le manque de donnees sur l&apos;utilisation des ressources en soins aigus chez les patients victimes d&apos;un traumatisme cranien (TC) nuit aux efforts pour ameliorer l&apos;efficience et la qualite de leurs soins. Notre objectif etait d&apos;evaluer les variations quant a l&apos;utilisation des ressources chez les patients victimes de traumatismes craniens entre les hdpitaux, d&apos;identifier les determinants d&apos;une grande utilisation des ressources et d&apos;analyser le lien entre l&apos;utilisation des ressources hospitalieres et les resultats cliniques. Methodes : Nous avons procede a une etude de cohorte retrospective multicentrique sur des patients ages de 16 ans et plus admis dans le systeme integre de traumatologie au Quebec apres un TC, entre 2013 et 2016. Nous avons estime l&apos;utilisation des ressources a partir des couts bases sur les activites. Les resultats cliniques incluaient mortalite, complications et rehospitalisation non planifiee. La variation entre les hdpitaux a ete evaluee a l&apos;aide de coefficients de correlation intra-classe (CCIC), avec des intervalles de confiance (IC) de 95 %. Les correlations entre l&apos;utilisation des ressources hospitalieres et les resultats cliniques ont ete evaluees a l&apos;aide de coefficients de correlation sur les estimations ponderees, ajustees en fonction du risque, avec des IC de 95 %. Resultats : Nous avons inclus 6319 patients. Nous avons observe des variations significatives entre les hdpitaux pour ce qui est de l&apos;utilisation des ressources chez les patients ayant recu leur conge de l&apos;hdpital et elle n&apos;a pas pu etre expliquee par la clientele (CCIC 0,052, IC de 95 % 0,043 a 0,061). L&apos;utilisation moyenne ajustee des ressources chez les patients transferes vers un etablissement de soins prolonges etait au-dela de 2 fois plus elevee que chez les patients ayant recu leur conge de l&apos;hopital. Les hopitaux qui ont utilise davantage de ressources ont eu tendance a avoir une incidence moindre de mortalite (r -0,347, IC de 95 % -0,559 a -0,087) et de readmissions non planifiees (r -0,249, IC de 95 % -0,481 a 0,020), mais une incidence plus elevee de complications (r 0,491, IC de 95 % 0,255 a 0,666). Conclusion : L&apos;utilisation des ressources pour les TC varie significativement d&apos;un hopital a l&apos;autre et pourrait etre associee a des differences de mortalite et de morbidite. Les associations negatives avec la mortalite et positives avec les complications devraient etre interpretees avec prudence, mais suggerent qu&apos;il y aurait lieu d&apos;analyser plus en profondeur le rapport entre evenements defavorables et survie.

Rationale: Patients with diabetes represent almost 20% of all ICU admissions and might respond differently to high-dose early active mobilization. Objectives: To assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial. Methods: All TEAM trial patients were included. The primary outcome was days alive and out of the hospital at Day 180. Secondary outcomes included 180-day mortality and long-term functional outcomes at Day 180. Logistic and median regression models were used to explore the effect of high-dose early mobilization on outcomes by diabetes status. Measurements and Main Results: All 741 patients from the original trial were included. Of these, 159 patients (21.4%) had diabetes. Patients with diabetes had fewer days alive and out of the hospital at Day 180 (124 [0–153] vs. 147 [82–164]; P = 0.013) and higher 180-day mortality (30% vs. 18%; P = 0.044). In patients receiving high-dose early mobilization, the number of days alive and out of the hospital at Day 180 was 73.0 (0.0–144.5) in patients with diabetes and 146.5 (95.8–163.0) in patients without diabetes (P value for interaction = 0.108). However, in patients with diabetes, high-dose early mobilization increased the odds of mortality at 180 days (adjusted odds ratio, 3.47; 95% confidence interval, 1.67–7.61; P value for interaction = 0.001). Conclusions: In this secondary analysis of the TEAM trial, in patients with diabetes, a high-dose early mobilization strategy did not significantly decrease the number of days alive and out of the hospital at Day 180, but it increased 180-day mortality. [ABSTRACT FROM AUTHOR]