Health care utilization and the cost of posttraumatic acute respiratory distress syndrome care

Post-traumatic acute respiratory distress syndrome (ARDS) is associated with prolonged mechanical ventilation and longer hospitalizations. The relationship between post-traumatic ARDS severity and financial burden has not been previously studied. We hypothesized that increasing severity is associated with incrementally higher health care costs.Adults arriving as the highest level of trauma activation were enrolled in an ongoing prospective cohort study. Patients who survived ≥6 hours are included in the analysis. Blinded review of chest radiographs was performed by two independent physicians for any intubated patient with PaO2:FiO2 ratio (P/F) ≤300mgHg during the first 8 days of admission. The severity of ARDS was classified by the Berlin criteria. Hospital charge data was utilized to perform standard costing analysis.ARDS occurred in 13% (203/1586). The distribution of disease severity was 33% mild, 42% moderate, and 25% severe. Patients with ARDS were older (41 vs 35 years, p<0.01), had higher median ISS (30 vs 10, p<0.01), more chest injury (AIS≥3: 51% vs 21%, p<0.01), and blunt mechanisms (85% vs 53%, p<0.01). By ARDS severity, there was no significant difference in age, mechanism, or rate of traumatic brain injury. Increasing ARDS severity was associated with higher ISS and higher mortality rates. Standardized total hospital charges were four-fold higher for patients who developed ARDS compared to those who did not develop ARDS ($434K vs $96K, p<0.01). Furthermore, the daily hospital charges significantly increased across categories of worsening ARDS severity (mild $20,451; moderate $23,994; severe $33,316, p<0.01).The development of post-traumatic ARDS is associated with higher health care costs. Among trauma patients who develop ARDS, total hospital charges per day increase with worsening severity of disease. Prevention, early recognition, and treatment of ARDS after trauma are potentially important objectives for efforts to control health care costs in this population.IV STUDY TYPE: Economic and Value-based Evaluations