Aim: To evaluate the cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury (TBI). Secondary aim was to identify factors associated with high inpatient rehabilitation cost. Method: Retrospective review of a tertiary hospital’s trauma registry was performed from 2011–2017. All patients aged 16 years or younger who sustained TBI with Glasgow Coma Scale ≤13 were included. Data on patient demographics, mechanism and severity of injury, hospital duration and inpatient rehabilitation cost were collected. We performed a regression analysis to identify factors associated with high rehabilitation cost. Results: There were a total of 51 patients. The median duration of inpatient rehabilitation was 13.5 days (interquartile range [IQR] 4–35), amounting to a median cost of SGD8,361 (IQR 3,543–25,232). Daily ward costs contributed the most to total inpatient rehabilitation cost. Those with severe TBI had longer duration of inpatient rehabilitation that resulted in higher cost of inpatient rehabilitation. Presence of polytrauma, medical complications, post-traumatic amnesia and TBI post-non-accidental injury (NAI) were associated with higher cost of inpatient rehabilitation. Conclusion: The cost of inpatient rehabilitation for paediatric patients post-TBI is significant in Singapore. Patients with TBI secondary to NAI had significantly higher cost of inpatient rehabilitation. Ways to reduce duration of hospitalisation post-TBI and early step-down care or outpatient rehabilitation should be explored to reduce cost.
The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range from USD5.9 billion–76.5 billion. Studies performed in the adult population reported that the direct cost of acute rehabilitation had been relatively similar over a 10-year period in the US from a median cost of USD53,119 per patient per year in 1993 to USD46,014 per patient per year in 2003. This cost stability could be due to the shorter duration of acute rehabilitation. Acute rehabilitation had been reported to account for at least one-third of the total hospitalisation cost in the paediatric population.
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