Analysis of Medical Costs for Trauma Patients

PURPOSE: We analyzed the medical costs for severely traumatized patients according to the severity and medical performance so that we couldimprove the financial balance of the trauma center. METHODS: Retrospective analysis was performed on patients visitingSNUH Trauma Center from May 2011 to August 2011. Among a total of 55 severely traumatized patients, 31 patients whose medical bills were available and categorized were included in this study. The injury severity score (ISS) was calculated from the abbreviated injury score (AIS), which was updated in 2008,for each patient to assess the severity of injury. Major trauma was defined as an ISS above 15. RESULTS: The 31 patients in this study included 20 males and 11 females. The average ISS was 33.23+/-16.65 points.We categorize the patients into three groups according to ISS, 16-24: group 1, 25-40: group 2, and above 41: group 3. Total incomes, admission fees, surgery fees, and imaging test fees are shown in table 1. The costs seem to be higher costs in group 2, but this result has no statistical significance. Statistical significantly data are as follows: high radiologic test fees in group 1, short hospital stay in groups 1 and 2, and short ICU stay in group 1. The averagehospital stay was 17 days, and the average emergency intensive care unit (EICU) stay was 7.5 days. Although the EICU stay was only 44% of the total hospital stay, the income from the EICU covers 79.4% of the total hospital income. CONCLUSION: From this study, we found several items that show relatively high medical income from severely traumatized patients visiting the SNUH Trauma Center. Most of the medical fees arise in the early phase of acute medicine usually in the ICU. Efforts to identify the items with high income and to minimize expenses will improve the financial structure of the Trauma Center,which is facing a budget crisis.

High Ligation for Indirect Inguinal Hernia in Young Adults

PURPOSE: The aim of this study was to compare three methods of hernioplasty: high ligation (HL), tissue repair (TR), and tension free (TF) and to determine the usefulness of high ligation for repair of indirect inguinal hernia in young adults. METHODS: One hundred thirty two patients who were under the age of 25 and who underwent repair of their inguinal hernia between January 2001 and December 2005 were reviewed retrospectively by using their inpatient and outpatient records and phone calls. Sixty seven, 23 and 42 patients underwent HL, TR and TF, respectively. The clinical features that were analyzed included location, type, signs and symptoms, operation method, complications and recurrence. RESULTS: The operation times were (mean+/-SD) 46.2+/-19.1, 56.0+/-11.5, and 61.8+/-14.9 minutes for HL, TR and TF, respectively. For the post-operative complications, there was 1 case of wound infection (1.5%) and 1 case of scrotal hematoma (1.5%) for HL; 1 case of wound infection (4.4%) and 1 case of scrotal swelling (4.4%) for TR; 3 cases of wound infection (7.0%), 2 cases of scrotal swelling (4.7%), 1 cases of intermittent pain (2.3%) and 1 case of scrotal hematoma (2.3%) for TF. Two patients in the HL group had recurrences, but there was no recurrence in the TR and TF groups. CONCLUSION: High ligation hernioplasty in young adults showed a shorter operation time, but there were no differences in the rate of complications between the methods. In the case of recurrence, it can be corrected by performing tissue repair or tension free hernioplasty because the normal anatomy may be preserved even after operation. Therefore, high ligation hernioplasty proved to be a useful method for repair of indirect inguinal hernia in young adults. In contrast, for the recurred or older age patients, tissue repair or tension free hernioplasty may be a more useful method.

The Diagnostic Value of Polymerase Chain Reaction in Mycoplasma pneumoniae Pneumonia

PURPOSE: This study was performed to evaluate the polymerase chain reaction (PCR) in the diagnosis of Mycoplasma pneumoniae pneumonia in comparison with the specific antibody test. METHODS: Five hundred and ten patients with pneumonia, ranging from the ages of 8 months to 15 years who were admitted in Sung-Ae and Kwangmyung Sung-Ae general hospitals from Nov. 1996 to Oct. 1997, were enrolled in this study. Specific antibody test of the serum using Serodia Myco II kit and PCR of the sputum or throat swab were performed on admission simultaneously, and follow-up antibody test was done during the convalescent stage if they showed sero-negative at first. Among the PCR positive patients, 40 were treated with erythromycin initially, and were followed with PCR on the 7th day of treatment. RESULTS: The sensitivity of PCR to the specific antibody test was 82.5%, and the specificity, 98.4%. The false positive and negative rates of PCR to the specific antibody test were 1.6% and 17.5%, respectively. Fifty-six (91.8%) of the 61 patients who showed sero-negative and PCR positive on admission were determined as sero-positive at the convalescent stage. Negative conversion of PCR at the convalescent stage was noted for 32 (80%) of 40 patients who were treated with erythromycin. CONCLUSION: The PCR was considered to be valuable due to its high sensitivity and specificity as a diagnostic method of Mycoplasma pneumoniae pneumonia. The effect of the method was more apparent than the specific antibody test in early diagnosis which is clinically important. In addition, it seems to be more useful in the appreciation of treatment and epidemiologic study than the culture method that shows low sensitivity and takes too much time.