Acute healthcare utilization by children after motor vehicle crashes

Infant car safety seats and risk of head injury

BACKGROUND/PURPOSE

We observed a high incidence of traumatic brain injuries (TBI) in properly restrained infants involved in higher speed motor vehicle crashes (MVCs). We hypothesized that car safety seats are inadequately protecting infants from TBI.

METHODS

We retrospectively queried scene crash data from our State Department of Transportation (2007-2011) and State Department of Public Health data (2000-2011) regarding infants who presented to a trauma center after MVC.

RESULTS

Department of Transportation data revealed 94% of infants in MVCs were properly restrained (782/833) with average speed of 44.6 miles/h when there was concern for injury. Department of Public Health data showed only 67/119 (56.3%) of infants who presented to a trauma center after MVC were properly restrained. Properly restrained infants were 12.7 times less likely to present to a trauma center after an MVC (OR=12.7, CI 95% 5.6-28.8, p<0.001). TBI was diagnosed in 73/119 (61.3%) infants; 42/73 (57.5%) properly restrained, and 31/73 (42.5%) improperly/unrestrained (p=0.34). Average head abbreviated injury scale was similar for properly restrained (3.2±0.2) and improperly/unrestrained infants (3.5±0.2, p=0.37).

CONCLUSION

Car safety seats prevent injuries. However, TBI is similar among properly restrained and improperly/unrestrained infants involved in higher speed MVCs who present to a trauma center.

Health care utilisation following hospitalisation for transport-related injury

BACKGROUND

Transport injuries are a substantial cause of disability and death internationally. There is little published information regarding patterns of healthcare utilisation following transport injury.

AIMS

To investigate patterns of in-hospital and post-discharge healthcare use following transport injury.

METHODS

Analysis of all accepted adult claims from the database of the transport accident compensation regulator in Victoria, Australia between 1995 and 2008. The analyses focused on injuries resulting in hospitalisation. Indicators of in-hospital and post-discharge healthcare utilisation (e.g. number of services per practitioner group) within the first 12-months were summarised.

RESULTS

More than a third (33.6%, n = 68,639) of all accepted compensable transport injuries resulted in admission to an acute care facility within 28 days of injury. In this group, the compensation authority paid for a total of 4.5 million healthcare services in the 12 months post-discharge (median of 19 services per claim). Services provided by medical practitioners were accessed by nearly all claimants (95.7%) at a median of 11 (5-26) per claimant. Less than half of claimants (46.7%) accessed paramedical or allied health services but the median number of services accessed was higher at 29 (9-82) per claimant.

CONCLUSION

Transport-related injury cases require a substantial interaction with multiple components of the healthcare system in the year following hospital discharge. Compensation system data may provide a detailed understanding of healthcare utilisation, a key element of injury burden.

Medicaid-based child restraint system disbursement and education and the vaccines for children program: comparative cost-effectiveness

OBJECTIVE

Low-income children are disproportionately at risk for preventable motor-vehicle injury. Many of these children are covered by Medicaid programs placing substantial economic burden on states. Child restraint systems (CRSs) have demonstrated efficacy in preventing death and injury among children in crashes but remain underutilized because of poor access and education. The objective of this study was to evaluate the cost-effectiveness of Medicaid-based reimbursement for CRS disbursement and education for low-income children and compare it with vaccinations covered under the Vaccines For Children (VFC) program.

METHODS

A cost-effectiveness analysis was performed of Medicaid reimbursement for CRS disbursement/education for low-income children based on data from public and private databases. Primary outcomes measured include cost per life-year saved, death, serious injury, and minor injury averted, as well as medical, parental work loss, and future productivity loss costs averted. Cost-effectiveness calculations were compared with published cost-effectiveness data for vaccinations covered under the VFC program.

RESULTS

The adoption of a CRS disbursement/education program could prevent up to 2 deaths, 12 serious injuries, and 51 minor injuries per 100,000 low-income children annually. When fully implemented, the program could save Medicaid over $1 million per 100,000 children in direct medical costs while costing $13 per child per year after all 8 years of benefit. From the perspective of Medicaid, the program would cost $17,000 per life-year saved, $60,000 per serious injury prevented, and $560,000 per death averted. The program would be cost saving from a societal perspective. These data are similar to published vaccination cost-effectiveness data.

CONCLUSION

Implementation of a Medicaid-funded CRS disbursement/education program was comparable in cost-effectiveness with federal vaccination programs targeted toward similar populations and represents an important potential strategy for addressing injury disparities among low-income children.

Epidemiologic patterns of injuries treated in ambulatory care settings

STUDY OBJECTIVE

Epidemiologic studies of injury morbidity have relied primarily on data from emergency departments (EDs) and hospital admissions. We seek to assess the incidences and characteristics of acute injuries treated at EDs and other ambulatory care settings.

METHODS

Using data from the 2002 National Health Care Survey on initial visits for acute injuries to EDs, physician offices, and hospital outpatient departments, we estimated the frequencies and incidence rates of medically attended injury by patient characteristics and care setting.

RESULTS

In the United States in 2002, 76 million nonfatal acute injuries received initial medical attention at EDs (46.2%), physician offices (47.8%), and outpatient departments (6.0%). The overall annual incidence rate of medically attended injury was 26.8 per 100 population (95% confidence interval 24.4 to 29.7). Falls accounted for 16.7% of all medically attended injuries. Injury patients who were black or uninsured were significantly more likely to visit EDs than other care settings for treatment. More than 2.4 million (3.2%) injury patients were admitted to hospitals, 96.6% of them through EDs.

CONCLUSION

Fewer than half of all medically attended acute injuries in the United States receive initial treatment in EDs. Injury severity and characteristics vary among care settings.