A comparison of diagnostic related group length of stay outliers: motor vehicle crash versus penetrating injuries

The incidence and degree to which patients injured by motor vehicle crashes (MVCs) and penetrating wounds remain in the hospital beyond the diagnostic related group (DRG) mean length of stay (LOS) are compared. During a 12-month period, records for consecutive patients admitted to eight hospitals (including three trauma centers) were studied. Patients aged 13 or younger, staying less than 48 hours, or with major burns or only distal fractures were excluded. In that time, 2,914 patients were eligible. Twenty percent of injuries were penetrating; 27% were MVC injuries; and, 53% were blunt injuries from other causes. Patients injured in MVCs and with penetrating injuries were compared with respect to mean LOS, incidence of DRG outliers, number of hospital days beyond the DRG mean LOS, and demographic variables. Patients injured in MVCs had a greater proportion of DRG LOS outliers and higher mean numbers of DRG excess days than did patients with penetrating wounds (p less than 0.01, for both). Injuries were distributed among relatively more DRGs for MVC patients. The DRG scheme may lack sufficient attention to factors more likely to affect MVC patients, such as multiplicity of injuries, incidence of CNS injuries, ICU requirements, and older age. In structuring more appropriate reimbursement for trauma care, special attention must be paid to patients injured in MVCs.