Clinical Factors and Expenditures Associated With ICD-9-CM Coded Trauma for the U.S. Population: A Nationally Representative Study

Acad Emerg Med. 2017 Apr;24(4):467-474. doi: 10.1111/acem.13143. Epub 2017 Mar 22.


Background: There is a lack of information on annual healthcare expenditures both per person and for the U.S. population associated with trauma, as identified by International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Methods: This paper employed a two-part model to estimate the unadjusted and adjusted annual per individual expenditures and population burden of trauma exposure for the U.S. population, using a nationally representative survey of medical care expenditures. In addition, we estimated a logit model to examine the demographic and comorbidity factors associated with the likelihood of experiencing trauma.

Results: Approximately 18.2% of U.S. adults were found to have trauma exposure during the survey year of 2011. The most frequent trauma ICD-9-CM code was injury not elsewhere classified/not otherwise specified. Adjusted likelihood of trauma was higher among individuals under the age of 65; males; non-Hispanic whites; nonmarried or never married; and individuals living with comorbidities of stroke, joint pain, arthritis, and asthma. The most expensive of the top 10 ICD-9-CM trauma codes was dislocation of the knee. Significant differences in expenditure categories were found for office-based, outpatient, emergency department (ED), dental, and other medical care. After adjustment for comorbidities and demographics, the adjusted per-person burden of trauma was estimated to be $1,689 (95% confidence interval [CI] = $1,006 to $2,372), with an incremental burden on the U.S. population of $60.8 billion per year.

Conclusions: Trauma results in a significant healthcare expenditure burden, both per person and on the U.S.

Population: Clinicians should be aware that individuals in the U.S. population with certain comorbidities such as stroke, joint pain, arthritis, and asthma are more likely to have trauma and that differences exist in expenditures for office-based, outpatient, dental, and the ED.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Comorbidity
  • Delivery of Health Care / methods*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Humans
  • International Classification of Diseases / statistics & numerical data*
  • Male
  • Middle Aged
  • United States / epidemiology
  • Wounds and Injuries / economics*
  • Wounds and Injuries / epidemiology