Hospital costs of trauma-related hospitalizations of children and adolescents in the State of the Pernambuco in 1999

Abstracts

Avaliou-se os gastos do Sistema Único de Saúde (SUS) com internações hospitalares de crianças e adolescentes, vítimas de traumatismos no estado de Pernambuco, no ano de 1999. Utilizou-se o banco de dados do Sistema de Informações Hospitalares do DATASUS, construído a partir das informações contidas nas Autorizações de Internação Hospitalar (AIH). Foram registradas 9.220 internações por causas externas a um custo de R$ 3.659.558,62, sendo 7.807 por traumatismos (84,7%). O custo médio no estado de Pernambuco nesse ano, para as internações por todos os diagnósticos na faixa etária de 0 a 19 anos, foi de R$ 306,49. Quando se computou apenas os traumatismos o custo médio passou para R$ 370,66. Os maiores gastos ocorreram com os traumatismos intracranianos e as fraturas de membros superiores e inferiores.

Traumatismo; Custos Hospitalares; Fraturas

ORIGINAL ARTICLE

Hospital costs of trauma-related hospitalizations of children and adolescents in the State of the Pernambuco in 1999

Roberto Natanael da Silva Mendonça^I; João Guilherme Bezerra Alves^II

^IMastership in Maternal-Infantile Health - IMIP

^IIAssociate Professor at the UPE and IMIP

^{Correspondence}

SUMMARY

The Brazilian National Unified Health System (SUS) expenditures related to hospitalizations of trauma children and adolescents in the Pernambuco State in 1999. were evaluated. Data were collected from the databank of the Hospital Information System of the DATASUS, based on information recorded on the Hospitalization Authorization Forms (AIH). A total of 9,220 hospital admissions by external causes were identified with a cost of R$ 3,659,558.62, with 7,807 hospitalizations due to trauma (84.7%). The mean cost of hospital admissions for children and adolescents in the Pernambuco State this year was R$ 306.49 versus a mean cost of hospital admissions for trauma of R$ 370.66. Head trauma and limb fractures were associated with higher costs.

Key words: Wounds and injuries; Hospital costs; Fractures.

INTRODUCTION

Trauma is the most frequent cause of death in subjects aged < 44 years. It is one of the most important public health problems both in developed and developing countries. It has a great effect upon morbimortality rates and is associated with a significant economical burden. The trauma costs include direct costs associated with treatment and indirect costs associated with productivity loss, specially when children and adolescents are the victims because of the greater life expectancy^(5,11).

Annual trauma costs amount to US$425 billion in the USA ⁽⁴⁾. In Latin America, the estimated annual economic costs associated with death and disability due to violence amount to approximately 20% of the total budget of the Health Ministry in each country⁽¹³⁾.

The true economic impact of trauma is difficult to evaluate. Not only the medical costs of treatment and rehabilitation, but also the costs related to the judicial and penal systems, the social costs of productivity loss, and material losses due to injuries must be taken into account⁽⁹⁾. Even in developed countries, the increased demand for services requested by these victims, together with the greater complexness of trauma management - sometimes involving complex technologies - has led to the deactivation of trauma care centers due to escalating costs⁽²⁾. The Pan-American Organization of Health reports that trauma care costs amount to 8% to 10% of the budget of hospitals provided with emergency room. In Brazil where violence has markedly increased, a marked rise in the number of trauma cases has being seen. Deslandes et al.⁽⁴⁾ have found an increase of 69% in federal expenditures related to the management of violence victims in the urban area of the Rio de Janeiro city during 1991-1993. Costs associated to violence are high but have not yet been clearly established.

Accurate trauma-related economic data are important for two reasons: the precise identification of trauma impact since this can be more effective in sensitizing political leaders than epidemiological data; they must be used as a parameter for the evaluation of the interventions adopted against violence.

The present study aims to identify trauma-related hospitalization costs of children and adolescents to the Brazilian National Unified Health System (SUS) during 1999 due to the importance of the matter and also because the Pernambuco State holds a prominent rank in the national violence panorama with a significant increase in mortality due to external causes in younger groups⁽¹⁾.

MATERIAL AND METHODS

Study site

There are approximately 184 counties and the State District of Fernando de Noronha in the Pernambuco state; the Pernambuco capital, the Recife city, is the most populous county with approximately 1,421,947 inhabitants in August/2000. The State population was 7,910,992 subjects with a demographic density of 78.37 inhabitants/km² and a concentration of 76.5% in the urban areas. The estimated population aged 15-19 years was 859,450 subject. In 1999, the total of beds available in the State for the SUS was 21,916 subjects, 11,906 of them (54.33%) located in the urban area of Recife⁽²⁾.

Data

A descriptive study was carried out using as an information source the summarized files of the CD-ROM database of the Hospital Information System of the Brazilian National Unified Health System (SIH-SUS) of DATASUS for the Pernambuco State in 1999 (Health Ministry, 1999). Hospital information were taken from the Hospitalization Authorization forms (AIH). AIH1 containing patient's identification, procedures, diagnosis, and treatments, accompanied by the respective codes of diagnosed diseases or conditions was used. A databank was then produced with the codes of the main diagnosis, according CD-10, included in chapters XIX and XX; the selected population was aged 0-19 years.

RESULTS

There were 190,485 hospitalizations of patients aged 0-19 years for all diagnoses in the Pernambuco state during 1999. Approximately 9,220 of them were due to external causes (4.8%) with 7,807 due to traumas; more male patients (71,4%) aged 10-19 years were hospitalized than female patients of the same age (55.3%).

The total cost to the SUS of hospitalizations for all age groups was R$ 212,073,716.90 in Pernambuco in 1999. When one considers hospitalization of patients aged <19 years, the cost was R$ 58,382,850.70 (mean cost of R$ 306.49 per patient). Diseases and conditions included in chapters XIX and XX corresponded to 6.27% of this total with a mean cost of R$ 396.91 per patient. The mean cost of hospitalizations per trauma was R$ 370.66.

Tables 1 to 6 show the main types of traumas with their respective costs according to the trauma site.

 

As for the cost per diagnosis, we observed that traumas were responsible for 77.9% of the total expenditures in the great Recife, followed by burns (15.2%), and complications and sequelae of external cause injuries (5.2%). Other external causes corresponded to 1.7% of diagnoses.

DISCUSSION

In the present study, the direct costs to the SUS of hospitalizations due to trauma were evaluated; costs of outpatient follow-up following hospital discharge and rehabilitation treatment were not taken into account. One must remember that costs are underestimated since costs of medical visits with no hospitalization were not taken into account. In addition, patients who were not seen by doctors and those who died where the event took place were excluded from the SUS data.

Costs of hospitalizations due to external causes to the SUS in the Pernambuco state were increased by 47.20% from 1996 to 1999. The total costs to the SUS of all hospitalizations in 1999 corresponded to approximately 0.05% of the GNP of the state⁽³⁾. A pioneer study of the estimated economical impact of accidents and violence in Brazil has shown that hospitalizations due to these causes throughout the country have resulted in an annual expenditure that corresponded to 0.07% of the national gross product in 1994⁽⁶⁾.

Traumas were the main causes of hospitalization in the Pernambuco state for all age groups and totalled 84.7%, with higher frequencies for the group aged 5-19 years. In urban areas, traumas are associated with a high risk of recurrence because there is a group of persons who are not only a victim of trauma, but also a victim of their high-risk behavior, with recurrence rates that may amount to 44% of cases when an adequate medical follow-up is available^(8,10,12).

Head and neck traumas were those responsible for higher costs to the SUS, head injury being responsible for 76.6% of the total expenditures of head and neck traumas. Other studies have shown that this type of trauma and those affecting the limb extremities are the most expensive ones^(7,8).

Our findings show that arm and leg fractures are, respectively, the second and the third cause of SUS expenditures. Mackenzie et al.⁽⁷⁾ observed that limb traumas corresponded up to 43% of the total costs of treatment.

One must emphasize that the overall costs to the public health system due to all types of trauma have not yet been extensively established since indirect costs cannot be evaluated due to the lack of precise data and nonmedical direct costs are difficult to measure. However, in order that the actual impact of trauma upon public health be evaluated as well as the social repercussions and the impact upon the productive workforce, research studies for that purpose must be continuously stimulated.

In order that public policy against trauma be effective, the public health service must define the risk populations in each region and the characteristics of their injuries and safety measures must be adopted. These data will be used by authorities when defining priorities for each area, city, or state.

Medical direct costs as described in the present paper are high. Resources would be better used in education and preventive programs rather than in the treatment, in many cases only palliative, for increasing deliberately inflicted injuries. Financial costs to the country have been very high, as well as the social costs. The search for definitive solutions is required because the fight against violence-related injuries may lead to medium- and long-term results if short-term results are not to be expected.

CONCLUSION

The cost to the SUS of trauma-related hospitalizations of children and adolescents was high in the Pernambuco state in 1999.

Traumas were the main causes of hospitalizations in the studied population and corresponded to more than 80% of those due to the external causes.

Traumas associated with higher costs to the SUS were head injury and limb fractures.

REFERÊNCIAS BIBLIOGRÁFICAS

Trabalho recebido em 26/08/2003.

Aprovado em 19/06/2004.

Work performed at Maternal-Infantile Institute of Pernambuco (IMIP)

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• 10. Minayo MCS, Deslandes SF. The complexity of relations between drugs, alcohol, and violence. Cad Saúde Pública 14:35-42, 1998.
• 11. Morrison W, Wright JL, Paidas CN. Pediatric trauma systems. Crit Care Med 30(Suppl.):448-556, 2002.
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Publication Dates

• Publication in this collection
  16 Nov 2004
• Date of issue
  Sept 2004

History

• Accepted
  19 June 2004
• Received
  26 Aug 2003