Browsing by Subject "Trauma Centers"
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Item The Burden of Gunshot Injuries on Orthopaedic Healthcare Resources in South Africa(2016-04-07) Martin, Case Wilemon; Nwariaku, Fiemu; Niwagaba, Lillian; Salazar, AdrianBACKGROUND: Injuries inflicted by gunshot wounds (GSW) are an immense burden on the South African healthcare system. In 2005, Allard et al. estimated South African state hospitals treat approximately 127,000 firearm victims annually and concluded the cost of treating an abdominal GSW is approximately USD 1,467 per patient. No study has been conducted to estimate the burden of GSWs from an orthopaedic perspective. OBJECTIVE: This study sought to estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in a South African tertiary level hospital. METHODS: This retrospective study surveyed over 1,500 orthopaedic admissions over a 12-month period in 2012 in Cape Town, South Africa at Groote Schuur Hospital (GSH) - an 893-bed university-affiliated state hospital. Chart review subsequently yielded data on, which allowed for cost analysis of, theatre time, number and type of implants, duration of admission, diagnostic-imaging studies performed, blood products used, laboratory studies ordered, and medications administered. RESULTS: A total of 111 patients with an average age of 28 years (range 13-74) were identified. Each patient was hit by an average of 1.69 bullets (range 1-7). These patients sustained a total of 147 fractures, the majority of which occurred in the lower extremities. Ninety-five patients received surgical treatment for a total of 135 procedures with a cumulative surgical theatre time of greater than 306 hours. Theatre costs, excluding implants, were in excess of USD 94,490. Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional USD 53,381 cumulatively, or USD 667 per patient. Patients remained in the hospital for an average of 9.75 days, and total costs were USD 130,427 (R1.106 million) for ward admissions, USD 21,583 for imaging, USD 22,563 for blood products, USD 1,914 for laboratory investigations, and USD 1,964 for discharge medication. Individual patient costs range from USD 20,046 to USD 305 for an average of about USD 2,940 (R24,944.68) per patient. CONCLUSION: This study assesses the burden of orthopaedic firearm injuries in South Africa. It estimates that on average treating an orthopaedic GSW patient costs USD 2,940, utilizes just over three hours of theatre time per operation, and necessitates a hospital bed for an average period of 9.75 days. With a greater understanding of not only the high incidence of orthopaedic GSWs treated in a South African tertiary care trauma center but also the costs incurred, the state healthcare system can better prioritize orthopaedic trauma funding and training opportunities while also supporting cost saving measures, including the redirection of financial resources to primary prevention initiatives.Item The Burden of Orthopaedic Gunshot Injuries on Healthcare Resources in South Africa(2015-01-26) Martin, Case; Maqungo, Sithombo; Thiart, Gerhard; McCollum, Graham; Roche, SteveBACKGROUND: Injuries inflicted by gunshot wounds (GSW) are an immense financial burden on the South African healthcare system. In 2005, Allard et al. estimated South African state hospitals treat approximately 127,000 firearm victims annually and concluded the cost of treating an abdominal GSW is approximately $1,467 per patient. No study has been conducted to estimate the burden from an orthopaedic perspective. OBJECTIVE: This study sought to estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in a South African tertiary level hospital. METHODS: This retrospective study surveyed over 1,500 orthopaedic admissions over a 12-month period in 2012 in Cape Town, South Africa at Groote Schuur Hospital (GSH) - a 893-bed university-affiliated state hospital. Chart review subsequently yielded data on, which allowed for cost analysis of, theatre time, number and type of implants, duration of admission, diagnostic-imaging studies performed, blood products used, laboratory studies ordered, and medications administered. RESULTS: A total of 111 patients with an average age of 28 years (range 13-74) were identified. Each patient was hit by an average of 1.69 bullets (range 1-7). These patients sustained a total of 147 fractures. The majority of injuries occurred in the lower extremities with 38.8% of all fractures in femurs, 15.6% in tibias, and 11.6% in fibulas. Ninety-five patients received surgical treatment for a total of 135 procedures with a cumulative surgical time of 220 hours 3 minutes. Cumulative anesthesia time was 306 hours 25 minutes. Theatre costs, excluding implants, were in excess of R800,000 (estimated $94,284). Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional R452,935 ($53,381) cumulatively, or R5,661.70 ($667.26) per patient. Total costs were in excess of R1 million for ward admissions, R180,000 for imaging, R190,000 for blood products, R16,000 for laboratory investigations, and R16,000 for discharge medication. Individual patient costs range from $18,603 to $305 for an average of about R24,834.43 ($2,927) per patient. INTERPRETATION: This study assesses the burden of orthopaedic firearm injuries in South Africa. It estimates that on average treating an orthopaedic GSW patient costs $2,927, utilizes about 3 hours of theatre time per operation, and necessitates a hospital bed for an average period of 10 days. With a greater understanding of not only the high incidence of orthopaedic GSWs treated in a South African tertiary care trauma center but also the costs incurred, the state healthcare system can better prioritize orthopaedic trauma funding and training opportunities while also supporting cost saving measures, including the redirection of financial resources to primary prevention initiatives.Item A Four-Year Experience at a Level I Pediatric Trauma Center: 2009-2012(2015-01-26) Stevens, Audrey; Renkes, Rachel; Burkhalter, Lorrie; Foglia, RobertBACKGROUND: In the United States, trauma is the leading cause of death and disability in children. Annually 140,000 children are seen in the Emergency Department(ED) at our single Level-I verified pediatric trauma center. 12,000 -13,000 are due to trauma, with approximately 1,400 admissions. We reviewed the trauma experience at our hospital to assess its impact based upon the management, outcome, and hospital charges for these patients. METHODS: With IRB approval, the hospital Trauma Registry was accessed to identify the severity of injury, management and outcomes for patients admitted from Jan. 2009 - Dec. 2012. Data points included age, gender, Trauma Activation (TA), Injury Severity Score (ISS), admit service, ICU admission, length of stay (LOS), operative need, mortality, and hospital charges. ED deaths were excluded. RESULTS: There were 5,514 trauma admissions, 8.18% of all of the 67,429 hospital admissions; 60% were boys and 40% girls. Age was 6.82±4.41 years, and ISS was 8.21±7.54. 54% had a minor ISS (0-7), 32% moderate (8-15), 9.5% severe (16-24), and 5.2% very severe (>24). TAs were called in 1346(24.4%) patients, 1014(75.3%) ALERTs and 332(24.7%) STATs. 2607 (47.3%) patients required an operation. The majority of patients were assigned to Pediatric Surgery (44%) and Orthopedic Surgery (41%). Trauma ICU admissions were 14.2% of all trauma admissions, comparable to all hospital ICU admissions at 17.4%. The trauma ICU LOS was 3.59±5.64 days; this doubled to 7.02±15.96 days for all hospital ICU admissions. The trauma LOS was 2.48±4.57 days; again, this doubled to 5.17±10.31 days for all hospital patients. There were 64 trauma deaths (1.16%). The trauma cohort accounted for $188,472,675 of hospital charges, which was 4.3% of all hospital charges ($4,375,099,917) for four years. The average charge per trauma patient was $36,746 vs. $65,324 for all admits. CONCLUSION: If trauma were a single disease, it would be the third most frequent admission diagnosis. The trauma population is heterogeneous; 24% of the trauma patients required TA, 14% ICU admission, 47% needed surgery, and 46% had a moderate or higher ISS. The mortality rate of 1.16% is less than the national average of 2.26%. Hospital charges and the LOS (total and ICU) for trauma patients were half that of all patients. The lower cost may be due to an efficient use of resources, management, and care of trauma patients. Our patient management and hospital charges for these trauma patients, coupled with good outcomes, may be a model for other hospital admissions and other trauma programs.Item [News](1984-08-03) Friar, JamieItem [News](1984-07-03) Friar, Jamie