engleski

War injuries in Croatia: cost and duration of hospitalization

War injuries heavily burden the hospital involved in treating these patients. Every injured patient requires surgical and medical treatment as well as physical and psychological support.1, 2 The Abbreviated Injury Scale (AIS) is a scoring system for determining the extent of anatomical injury.3 It is divided into five scores: AIS 1, light injuries ; AIS 2, injuries of medium severity ; AIS 3, severe injuries not endangering life ; AIS 4, serious injuries endangering life ; and AIS 5, severe injuries with uncertain survival.3 We studied the duration of hospitalization and the cost incurred on war injuries in relation to the AIS score in one of the Croatian hospitals close to the battlefront. The war in Croatia lasted from 1991 to 1995.4, 5 Providing treatment to numerous civilians and soldiers injured in the war was a difficult but challenging task for the Split University Hospital on the Adriatic coast, which had earlier been functioning as a civilian hospital. During 1991, the hospital had to be rapidly adapted to working under war conditions.2 It functioned both as a civilian and military hospital serving the whole of South Croatia and parts of Bosnia and Herzegovina. Due to the intensification of war in South Croatia and particularly in Bosnia and Herzegovina during 1992– 93, the number of patients with war injuries increased, as did the overall duration and total cost of hospitalization.4– 6 We analysed the medical records of 2158 patients with war injuries treated at the Departments of Surgery and Traumatology, Split University Hospital from 1991 to 1995. The majority of them (66.5%) were treated in 1992– 93. War injuries were analysed and classified according to the AIS. The AIS score was based on the consensus of two physicians who had independently reviewed each medical record. Most of the patients were in the AIS 3 (32.8%) group, followed by the AIS 4, AIS 2 and AIS 5 groups, with the AIS 1 group being the smallest (5%). The total hospitalization time was 37 883 days. The longest period of hospitalization was in the AIS 3 group and the shortest in the AIS 5 group. We calculated the expenses of hospitalization and treatment of patients with war injuries according to the price list of the State Institute for Health Insurance. The average cost of hospitalization was US$ 70 per patient per day.7 The duration and expenses of hospitalization increased significantly from the AIS 1 to AIS 4 group (Table I). Patients in the AIS 3 and AIS 4 groups had significantly longer hospitalization times and greater treatment expenses than those in AIS 1 and AIS 2. The AIS 4 group had more expensive and longer hospitalization than AIS 3. The duration of hospitalization and expenses of patients in the AIS 5 group were significantly lower than those in the AIS 4 and AIS 3 groups, and did not differ from that of patients in AIS 1 and AIS 2. The low cost incurred for patients in AIS 5 was probably because the severity of the injuries in this group led to a rapidly fatal outcome in 21.9%. The cost of treatment to the Split University Hospital was US$ 2.6 million. The majority of patients were citizens of Bosnia and Herzegovina (60%) and the cost of their treatment was US$ 1.8 million (69.2% of the total cost). War injuries were indeed a heavy burden to the already weak healthcare system.7 However, these expenses and efforts were warranted because of the human lives saved.

war injuries; Croatia; hospitalization

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