2006 Volume 15 Issue 7 Pages 491-497
In the last decade, we have experienced substantial changes of medicosocial systems, e.g. introductions of the treatment guidelines, the diagnosis-related groups/prospective payment system by diagnosis procedure combination (DPC), and the compulsory system for postgraduate clinical training, which may influence medical affairs and hospital management. The present study evaluated the impact of these alterations on severe head injury management. The results indicated that the executing rates of brain hypothermia, steroid therapy, barbiturate therapy, and hyperventilation therapy decreased, while the rate of hypertonic diuretic therapy increased. The executing rate of intracranial pressure (ICP) monitoring showed the largest reduction. Analysis of medical expenses revealed that the expense for "medical procedure", which includes the cost for ICP monitoring, etc, showed a large decrease, suggesting that DPC attenuated the execution of medical procedures at bed side. These findings suggest that management of severe head injury has become uniformed and simplified in the last decade.