The Economics of Fatal Injury

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Abstract
This study reviewed the direct costs (charges for goods and services) for 77 consecutive patients who presented to this trauma service with a Trauma Score (TS) of four or less. Seventy-four patients died (96.1%). The survival rates based upon the Trauma Scores were: TS 1, 0(0/34); TS 2, 0(0/9); TS 3, 7.7%(1/13); TS 4, 9.5%(2/21). Only four nonsurvivors lived more than 24 hours. The remaining 70 patients died within 24 hours without achieving even transient cardiovascular stability. Three of the 77 patients survived (3.9%) but only one achieved a productive recovery. The total direct cost for the 77 patients was $544,477.66. Physician fees, which accounted for 26.7% of the direct costs, averaged $1,887.57 per patient (range, 0–$11,291.00). The average direct cost for the three survivors was $50,138.94. The average direct cost for nonsurvivors was $5,325.18 ($3,383.29 for patients with a TS 1 or 2, $8,018.76 for patients with a TS 3 or 4). The hospital direct costs for nonsurvivors ranged from $40.00 for a patient declared dead on arrival to $57,817.91 for a patient who died 41 days after admission. It is futile to continue resuscitational efforts if a valid Trauma Score of 1 or 2 is confirmed shortly after the initiation of appropriate resuscitative measures. Continued therapy is futile for the remainder of patients admitted with Trauma Scores of 4 or less if they do not achieve cardiovascular stability in response to appropriate resuscitative measures within 1 hour of admission. These clinical guidelines identify fatally injured patients who present with a Trauma Score of 4 or less, and thus offer a method to minimize the direct costs of fatal injury.

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