Superusers: Drivers of health care resource utilization in the national trauma population

• Published in: Surgery Vol. 164; no. 4; pp. 848 - 855
• Main Authors: Gil, Lindsay A., Kothari, Anai N., Brownlee, Sarah A., Ton-That, Hieu, Patel, Purvi P., Gonzalez, Richard P., Luchette, Fred A., Anstadt, Michael J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2018
• Subjects: Adolescent; Adult; Aged; Comorbidity; Databases, Factual; Female; Health Resources - economics; Health Resources - statistics & numerical data; Humans; Male; Middle Aged; Patient Acceptance of Health Care - statistics & numerical data; Risk Factors; Trauma Severity Indices; United States - epidemiology; Wounds and Injuries - economics; Wounds and Injuries - epidemiology; Wounds and Injuries - therapy; Young Adult; United States
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2018.04.046

Health care spending is driven by a very small percentage of Americans, many of whom are patients with prolonged durations of stay. The objective of this study was to characterize superusers in the trauma population.
The National Trauma Data Bank for 2008–2012 was queried. Superusers were defined as those with a duration of stay in the top 0.06% of the population and were compared with the remainder of the population to determine differences in demographic characteristics, comorbidities, prehospital factors, and outcomes. Multivariate analysis was used to determine independent predictors of being classified as a superuser.
A total of 3,617,261 patients met inclusion criteria, with 34,728 qualifying as superusers. Mean duration of stay for superusers was 58.7 days compared with the average 4.6 days (P < .001). Superusers were more likely to be male, black, Medicaid insured, and have a higher Injury Severity Score and lower Glasgow Coma Scale score. The hospital course of superusers was likely to be complicated by pneumonia, acute respiratory distress syndrome, decubitus ulcer, and acute kidney injury.
Age, sex, race, and insurance were associated with prolonged use of inpatient care in the trauma patient population. Specific comorbidities and complications are associated with being a superuser. This subset of the trauma population confers a disproportionate burden on the health care system and can serve as a potential target for intervention.