Study: Minimally injured people sent to trauma centers cost hundreds of millions per year

September 10, 2013, Oregon Health & Science University

During a three-year period in seven metropolitan areas in the western United States, the emergency medical services system sent more than 85,000 injured patients to major trauma hospitals who didn't need to go there—costing the health care system more than $130 million per year, according to an Oregon Health & Science University study published today in the journal Health Affairs.

The study gathered data from emergency services calls from 94 EMS agencies in the seven metropolitan areas from January 2006 through December 2008. The agencies were using national triage guidelines to decide where to transport the injured patients, so the study's findings are likely representative of what happens across the United States.

"What our study shows is there are huge cost implications in how EMS systems work to get injured patients to the appropriate hospitals," said Craig Newgard, M.D., an associate professor of emergency medicine at OHSU who is director of the OHSU Center for Policy and Research in Emergency Medicine and the study's lead author. "And it shows how very early decisions in the process of health care—even prior to a patient arriving at the —can lead to much higher costs downstream for our ."

The OHSU study gathered data from EMS agencies in the of Portland/Vancouver, Sacramento, Calif., Santa Clara, Calif., and Salt Lake City, Utah. It also gathered data from King County (Seattle) in Washington state, San Francisco, Calif., and Denver County of Colorado.

The data showed that more than 301,000 injured people were transported to hospitals in the seven regions during the study period. About 248,000 of them were "low-risk" patients who, if the EMS national triage guidelines had been followed, should not have been taken to hospitals. More than a third of those patients—more than 85,000—were taken to a major trauma hospital.

The results were higher costs to the health care system because the cost of care at trauma hospitals is significantly higher than at non-trauma hospitals. Care at major trauma centers costs more due to several factors, including the around the clock availability of trauma surgeons and other experts who provide care to the most complex patients and the necessary technology and resources required to care for these patients.

The OHSU study found that the average cost of care for a trauma patient at a Level 1 trauma hospital—the most advanced level—was $5,590 higher than at a non-trauma hospital. Even when restricted to patients with minor injuries, the average per-patient cost at Level I trauma centers was $4,833 higher than non-trauma hospitals.

"Care in major trauma centers is expensive and that is very justifiable for patients who need that level of care," Newgard said. "But among patients who are minimally injured, that translates into large excess costs."

Because the severity of injury is often not apparent at the scene, the national EMS guidelines include more than two dozen "triage criteria" for deciding whether a patient should be taken to a major trauma center following an injury event. Among the criteria are low blood pressure, confusion, penetrating injury to the torso and high-risk auto crashes. Generally, if any of the criteria is met, the guidelines say the patient should be taken to a trauma center.

Newgard said the study did not explore the reasons that patients who didn't meet the criteria were taken to major anyway. But a follow-up study that he's leading suggests major reasons include patient request and hospital proximity.

A co-author on the paper was John McConnell, Ph.D., director of OHSU's Center for Health Systems Effectiveness, which explores a wide range of health economics issues.

"A lot of current efforts aimed at slowing healthcare spending are focused on patients with chronic illness, but we need to think more carefully about out-of-hospital and trauma services," said McConnell. "This study shows that there are substantial cost savings that may be obtained if we can improve our ability to guide to an appropriate level of care."

Explore further: Chronic illness puts pediatric trauma patients at higher risk

Related Stories

Chronic illness puts pediatric trauma patients at higher risk

August 6, 2013
In a recent study published in the Journal of Trauma and Acute Care Surgery, researchers from the Center for Injury Research and Policy in The Research Institute at Nationwide Children's Hospital found that pediatric trauma ...

Car crash victims more likely to survive if taken directly to a trauma centre

June 8, 2012
People who are seriously injured in a car accident are more than 30 per cent more likely to survive at least 48 hours if they are taken directly to a trauma centre than those who are taken first to a non-trauma centre, new ...

Injured children may not be getting best possible care

May 2, 2011
Most injured children are not being treated at pediatric trauma centers, arguably the most appropriate location of care for young patients, according to a study to be presented Monday, May 2, at the Pediatric Academic Societies ...

Women with severe injuries are less likely than men to be treated in a trauma center

May 20, 2013
Women are less likely than men to receive care in a trauma center after severe injury, according to a new study of almost 100,000 Canadian patients.

Emergency helicopter airlifts help the seriously injured

June 21, 2013
Patients transferred to hospital via helicopter ambulance tend to have a higher survival rate than those who take the more traditional road route, despite having more severe injuries. The research, published in BioMed Central's ...

New study examines cost-effectiveness of helicopter transport of trauma victims

April 25, 2013
Researchers at the Stanford University School of Medicine have for the first time determined how often emergency medical helicopters need to help save the lives of seriously injured people to be considered cost-effective ...

Recommended for you

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.