Terrence H. Liu

Pan computed tomography versus selective computed tomography in stable, young adults after blunt trauma with moderate mechanism: a cost-utility analysis.

BACKGROUND Pan computed tomography (PCT) of the head, cervical spine, chest, abdomen, and pelvis is a valuable approach for rapid evaluation of severely injured blunt trauma patients. A PCT strategy has also been applied for the evaluation of patients with lower injury severity; however, the cost-utility of this approach is undetermined. The advantage of rapidly identifying all injuries via PCT must be weighed against the risk of radiation-induced cancer (RIC). Our objective was to compare the cost-utility of PCT with selective computed tomography (SCT) in the management of blunt trauma patients with low injury severity. METHODS A Markov model–based, cost-utility analysis of a hypothetical cohort of hemodynamically stable, 30-year-old males evaluated in a trauma center after motor vehicle crash was used. CT scans are performed based on the mechanism of injury. The analysis compared PCT with SCT over a 1-year time frame with an analytic horizon over the lifespan of the patients. The possible outcomes, utilities of health states, and health care costs including RIC were derived from the published medical literature and public data. Costs were measured in US 2010 dollars, and incremental effectiveness was measured in quality-adjusted life-years (QALYs) with 3% annual discounted rates. Multiway sensitivity analyses were performed on all variables. RESULTS The total cost for blunt trauma patients undergoing PCT was

Hospital-centered violence intervention programs: a cost-effectiveness analysis

15,682 versus

Emergency uncrossmatched transfusion effect on blood type alloantibodies.

17,673 for SCT. There was no difference in QALYs between the two populations (26.42 vs. 26.40). However, there was a cost savings of

Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective

75 per QALY for patients receiving PCT versus SCT (

Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma.

594 per QALY vs.

Admission serum lactate levels do not predict mortality in the acutely injured patient.

669 per QALY). CONCLUSION PCT enables surgeons to identify and rule out injuries promptly, thereby reducing the need for inpatient observation. The risk of RIC is low following a single PCT. This cost-utility analysis finds PCT based on mechanism to be a cost-effective use of resources. LEVEL OF EVIDENCE Economic and value-based evaluations, level II.

Single-Contrast Computed Tomography for the Triage of Patients With Penetrating Torso Trauma

BACKGROUND Hospital-centered violence intervention programs (HVIPs) reduce violent injury recidivism. However, dedicated cost analyses of such programs have not yet been published. We hypothesized that the HVIP at our urban trauma center is a cost-effective means for reducing violent injury recidivism. METHODS We conducted a cost-utility analysis using a state-transition (Markov) decision model, comparing participation in our HVIP with standard risk reduction for patients injured because of firearm violence. Model inputs were derived from our trauma registry and published literature. RESULTS The 1-year recidivism rate for participants in our HVIP was 2.5%, compared with 4% for those receiving standard risk reduction resources. Total per-person costs of each violence prevention arm were similar:

Quantification of Surgical Resident Stress “On Call”

3,574 for our HVIP and

BRAF mutation in papillary thyroid cancer: A cost-utility analysis of preoperative testing.

3,515 for standard referrals. The incremental cost effectiveness ratio for our HVIP was

Antibiotics vs Appendectomy as Initial Treatment for Uncomplicated Acute Appendicitis: A Cost-Effectiveness Analysis

2,941. CONCLUSION Our HVIP is a cost-effective means of preventing recurrent episodes of violent injury in patients hurt by firearms.