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ORIGINAL ARTICLE
Year : 2017  |  Volume : 44  |  Issue : 1  |  Page : 31-35

Cost of initial management of musculoskeletal injuries due to road traffic crashes: A register-based study from North-West India


1 Department of Orthopaedics, Dr. R. P. Government Medical College, Tanda, Kangra, Himachal Pradesh, India
2 Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Kangra, Himachal Pradesh, India

Date of Web Publication20-Mar-2017

Correspondence Address:
Sunil Kumar Raina
Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Kangra, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_28_16

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  Abstract 

Background: There is a paucity of information on the actual costs incurred by the family as a result of musculoskeletal injuries due to road traffic crash from our part of India. This study was conducted with the objective to ascertain the costs of initial management of musculoskeletal injuries due to road traffic crashes. Materials and Methods: This prospective study was conducted as a register-based descriptive study in a tertiary care teaching hospital in a rural area (with a predominantly mountainous terrain) of North-West India. All patients with nonfatal musculoskeletal injuries due to road traffic crashes, presenting between 2014 and 2015 and agreeing to participate in the study were included in the study. Results: Of 313 cases, 116 were managed conservatively, whereas in 189 cases, operative intervention was required. In 8 cases, both the modalities of management were required. The average cost of management was Rs. 20,386 in operative group. The average cost in the conservative group was Rs. 3726. Average cost calculated for patients in whom both modality of treatment was required was Rs. 24,000. It was observed that the indirect cost of management was proportionately higher in conservative group. Conclusions: The initial cost of management for patients managed conservatively is less than those managed by operative intervention. Importantly, however, the indirect cost of management is a major contributor to the total cost of management.

Keywords: Cost, initial management, musculoskeletal injuries, road traffic crashes


How to cite this article:
Awasthi B, Raina SK, Verma L, Kalia S. Cost of initial management of musculoskeletal injuries due to road traffic crashes: A register-based study from North-West India. J Sci Soc 2017;44:31-5

How to cite this URL:
Awasthi B, Raina SK, Verma L, Kalia S. Cost of initial management of musculoskeletal injuries due to road traffic crashes: A register-based study from North-West India. J Sci Soc [serial online] 2017 [cited 2017 May 29];44:31-5. Available from: http://www.jscisociety.com/text.asp?2017/44/1/31/202543


  Introduction Top


Each year about 1.2 million people die and between 20 and 50 million suffer nonfatal injuries across the world.[1] Whereas data on the morbidity and mortality due to crashes are available, data estimating economic losses incurred as a result of injuries is limited. It appears that the figures on the probable costs of road traffic crashes available at the national and state level are arrived at using crude estimates only. Most of the studies on costing of road traffic crashes are primarily based on secondary data collection, wherein data have been either collected from insurance agencies or claim tribunals.[2],[3],[4],[5],[6],[7] Furthermore, there is a paucity of information on the actual costs incurred by the family as a result of musculoskeletal injuries due to road traffic crash from our part of India. To cover for this gap in our knowledge, this study was conducted with an objective to ascertain the costs of initial management following road traffic.


  Materials and Methods Top


This prospective study was conducted as a register-based descriptive study in a tertiary care teaching hospital in a rural area (with a predominantly mountainous terrain) of North-West India. Patients with nonfatal musculoskeletal injuries due to road traffic crashes of all age group, presenting between 2014 and 2015 and agreeing to participate were included in the study. The study was approved by the Institution Ethics Committee.

Patient (enrolled in the study) and their attendants were adequately informed of the aims, methods, the anticipated benefits and potential risks of study and the discomfort and the remedies thereof. Written informed consent was obtained from all the patients and attendants included in the study. In case of minors, consent was taken from the parents/local guardians.

After the completion of the initial management at the institution, the patients and their attendants were inquired about the estimated cost of the management. The estimated cost was grouped as direct and indirect cost. The indirect cost included costs incurred on transportation, lodging, and boarding, whereas the direct cost included cost on radiological as well as blood investigation, cost of implant, and other items required for surgery. All relevant medical records and bills available were reviewed for calculation of cost. All the information collected was entered in the Performa made for data collection. The data collection process was performed through personal interviews with the patient and their attendants.


  Results Top


A total of 368 patients presenting with nonfatal musculoskeletal injuries due to road traffic crashes were registered for the inclusion of which 313 completed the study yielding a response rate of 85%. Out of a total of 313 patients of musculoskeletal injuries, 116 patients were managed conservatively, whereas in 189 cases, operative intervention was requires [Table 1]. In eight cases both the modalities of management were required. The average cost of management in operative group was Rs. 21,014, whereas the average cost of management in conservative group was estimated at Rs. 3716. Patients managed with both modalities of treatment, the cost was estimated at Rs. 24,000. It is also observed that in conservative group indirect cost of management is proportionately high in comparison to the operative group [Table 1]. [Table 2] provides details on the initial management cost of spinal fractures due to road traffic crashes. Out of a total of 11 cases of spine injury 8 participants had isolated injuries of spine, whereas three participants also had associated injuries. The initial cost of management in isolated injuries of spine was estimated at Rs. 12,750, whereas the cost estimated for multiple fractures was Rs. 12,666. The estimated costs were found to be the highest for cervical spine injuries.
Table 1: Initial cost of management of musculoskeletal injuries due to road traffic crashes

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Table 2: Initial management cost in spinal fractures in road traffic crashes

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[Table 3] shows that out of 66 patients of musculoskeletal injuries due to road traffic crashes involving the upper extremity, forty patients had isolated fracture of the single bone, whereas 26 patients had multiple fractures. The average total cost of initial management in isolated fractures in the upper limb was estimated at Rs. 13,866 whereas the cost of initial management in multiple fractures in the upper limb was estimated at Rs 22,998. The details of the cost (direct and indirect) of the individual fractures are provided in [Table 3]. [Table 4] provides details of the cost in managing fractures of small bones of hand. The average total cost of initial management in isolated fractures of small bones of hand was estimated at Rs. 1641 while the cost of initial management in multiple fractures of small bones of hand was estimated at Rs. 9500. The details of the cost (direct and indirect) of the individual fractures are provided in [Table 4].
Table 3: Initial management cost in upper limb fractures in road traffic crashes

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Table 4: Initial management cost of small bones of hand in road traffic crashes

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Average total cost of initial management in isolated fractures in the lower limb was estimated at Rs. 18,813, whereas the average cost of initial management in multiple fractures in the lower limb was estimated at Rs 29,107 [Table 5]. The details of the cost (direct and indirect) of the fractures are provided in [Table 5]. The details of the cost (direct and indirect) of the fractures of small bones of foot are provided in [Table 6]. Average total cost of initial management in isolated fractures of small bones of foot was estimated at Rs. 3392 while the average cost of initial management in multiple fractures of small bones of foot in the lower limb was estimated at Rs. 22,125.
Table 5: Initial management cost in lower limb fractures in road traffic crashes

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Table 6: Initial management cost of small bones of foot in road traffic crashes

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  Discussion Top


Road traffic accident costs 1%–2% of gross national product in low to middle-income countries, and account for a loss of about USS$ 65 billion every year.[8] In a prospective, descriptive hospital based, conducted over 1 year at a tertiary care center in a rural area of Himachal Pradesh, it was found out that musculoskeletal injuries due to road safety assessments are common in productive age (16–30 years).[9] Findings similar to this were also observed in a hospital-based descriptive study conducted at high altitude, emphasizing on the need for cost calculations.[10]

Studies in the past have reflected on the total costs entailed by the society in terms of loss to productivity and thereby the costs incurred.[8],[11] The current study was focused on the cost of the injury to the individual and the family in terms of initial management of fractures due to road traffic crashes.

The study points out that the initial cost of management in isolated injuries of spine was estimated at Rs. 12,750, whereas the cost estimated for multiple fractures was Rs. 12,666. The estimated costs were found to be higher for cervical spine injuries in comparison to dorsal and lumbar spine.

The most probable reason for this difference could be that the majority of the dorsal and lumbar spine fracture encountered in the study was of stable type. There was no neurological deficit associated with these factures, hence were managed conservatively. Contrary to this, the cervical spine fracture, encountered in the study were of unstable type, with neurological deficit in the form of quadriparesis and quadriplegia. The initial management cost of facture of the calcaneum was found to be the least. This, because the majority of the fractures of the calcaneum were managed conservatively. The initial cost of the management of intertrochanteric fracture was estimated to be very high. This may be due to the fact that hip arthroplasty was chosen as mode of the treatment in some cases of cervicotrochanteric fractures thereby increasing the cost. The cost estimate for arthroplasty included the cost of the prosthesis. Further patients managed with arthroplasty had a longer stay in the hospital.

The present study shows that the average cost entailed by the patient or his family also depends on the size of the bone involved in the injury. Therefore, the small tubular bone of the hand (metacarpals) cost much less as compared with the bone of the forearm and arm. The study also highlights the contribution of indirect costs in total costs on initial management of musculoskeletal injuries to road traffic crashes. While the average cost of management was Rs. 20,386 in operative group, the average cost in the conservative group was estimated at Rs. 3726. Average cost calculated for patients in whom both modality of treatment was required was Rs. 24,000. The contribution of indirect costs to patients managed either with operative or conservative modality, was significant. The indirect cost of management was proportionately higher in conservative group, wherein the total costs was much lower than operative group.

As per a study conducted in Iran, the RTAs economic burden was 589,448.49 USD, and this accounted for 10.4% of total hospital expenses during the study.[12] The high indirect cost estimates in our study are a cause of concern as are an avoidable part of economic burden to patients with musculoskeletal injuries due to road traffic crashes.

Limitations

A larger time frame of the study with a bigger sample size may give us a better idea on the initial cost of management of injuries.

Recommendation

Establishment of a trauma register with cost estimation of management forming a part of it will go a long way in establishing management protocols for injuries.


  Conclusions Top


The initial cost of management for patients managed conservatively is less than those managed by operative intervention with the indirect cost of management acting as a major contributor to the total cost of management. The higher cost of management is a financial barrier which needs to be overcome. In view of this, it is important for health care managers to arrive at cost estimates (direct and indirect) of management of musculoskeletal injuries to bring down the total costs of management of injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Global Status Report on Road Safety: Time for Action. Geneva: World Health Organization; 2009.  Back to cited text no. 1
    
2.
Mohan D. The Road Ahead: Traffic Injuries and Fatalities in India. Final Report. New Delhi: Transportation Research and Injury Prevention Programme, Indian Institute of Technology; 2004.  Back to cited text no. 2
    
3.
Bastida JL, Aguilar PS, González BD. The economic costs of traffic accidents in Spain. J Trauma 2004;56:883-8.  Back to cited text no. 3
    
4.
van Beeck EF, van Roijen L, Mackenbach JP. Medical costs and economic production losses due to injuries in the Netherlands. J Trauma 1997;42:1116-23.  Back to cited text no. 4
    
5.
Natatrajan T. Costs of road crashes. College of Engineering. Guindy, Madras: Department of Traffic and Urban Engineering; 1980.  Back to cited text no. 5
    
6.
Road User Cost Study in India. Final Report. New Delhi: Central Road Research Institute; 1982.  Back to cited text no. 6
    
7.
Evaluation of road crash costs: Research digest. Indian Highways 2000;28:27-44.  Back to cited text no. 7
    
8.
Kahjuria B, Sharma R, Verma A. A profile of the autopsies of road traffic accident victims in Jammu. J Clin Diagn Res 2008;4:639-42.  Back to cited text no. 8
    
9.
Raina SK, Thakur L, Awasthi B, Sharma V, Kalia S. Sociodemography of musculo- skeleletal injuries due to roadside accidents: A register – Based study from North-West India. Trop J Med Res 2016;19:110-3.  Back to cited text no. 9
  [Full text]  
10.
Mahajan N, Aggarwal M, Raina S, Verma LR, Mazta SR, Gupta BP. Pattern of non-fatal injuries in road traffic crashes in a hilly area: A study from Shimla, North India. Int J Crit Illn Inj Sci 2013;3:190-4.  Back to cited text no. 10
  [Full text]  
11.
Reddy GM, Singh A, Singh D. Community based estimation of extent and determinants of cost of injuries in a North Indian city. Indian J Med Sci 2012;66:23-9.  Back to cited text no. 11
  [Full text]  
12.
Sargazi A, Sargazi A, Nadakkavukaran Jim PK, Danesh H, Aval F, Kiani Z, et al. Economic burden of road traffic accidents; report from a single center from South Eastern Iran. Bull Emerg Trauma 2016;4:43-7.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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Introduction
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