• Imen Farhat, Lynne Moore, Teegwendé Valérie Porgo, Coralie Assy, Amina Belcaid, Simon Berthelot, Henry T Stelfox, Belinda J Gabbe, François Lauzier, Julien Clément, and Alexis F Turgeon.
• Department of Social and Preventive Medicine, Université Laval, Québec (QC), Canada.
• Ann. Surg. 2022 Jan 1; 275 (1): e107e114e107-e114.

ObjectiveEvaluate interhospital variation in resource use for in-hospital injury deaths.BackgroundSignificant variation in resource use for end-of-life care has been observed in the US for chronic diseases. However, there is an important knowledge gap on end-of-life resource use for trauma patients.MethodsWe conducted a multicenter, retrospective cohort study of injury deaths following hospitalization in any of the 57 trauma centers in a Canadian trauma system (2013-2016). Resource use intensity was measured using activity-based costing (2016 $CAN) according to time of death (72 h, 3-14 d, ≥14 d). We used multilevel log-linear regression to model resource use and estimated interhospital variation using intraclass correlation coefficients (ICC).ResultsOur study population comprised 2044 injury deaths. Variation in resource use between hospitals was observed for all 3 time frames (ICC = 6.5%, 6.6%, and 5.9% for < 72 h, 3-14 d, and ≥14 d, respectively). Interhospital variation was stronger for allied health services (ICC = 18 to 26%), medical imaging (ICC = 4 to 10%), and the ICU (ICC = 5 to 6%) than other activity centers. We observed stronger interhospital variation for patients < 65 years of age (ICC = 11 to 34%) than those ≥65 (ICC = 5 to 6%) and for traumatic brain injury (ICC = 5 to 13%) than other injuries (ICC = 1 to 8%).ConclusionsWe observed variation in resource use intensity for injury deaths across trauma centers. Strongest variation was observed for younger patients and those with traumatic brain injury. Results may reflect variation in level of care decisions and the incidence of withdrawal of life-sustaining therapies.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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