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Young Athlete Injury Outcome Study (IOS): Healthcare Burden Analysis - - PowerPoint PPT Presentation
Young Athlete Injury Outcome Study (IOS): Healthcare Burden Analysis - - PowerPoint PPT Presentation
Young Athlete Injury Outcome Study (IOS): Healthcare Burden Analysis Emory Co-Investigators: Heather L. Saffel, MD; Emily L. DeMaio, BSN; Sarah J. Cato, BS; Ally E. Render; Rajiv Verma, DO; Neeru Jayanthi, MD Study PI [Emory]: Dr. Neeru Jayanthi,
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Grant Funding
- Emory University Department of
Orthopaedics (2018)
- Seed Grant ($2,500)
- American Medical Society for
Sports Medicine (2019)
- Foundation Grant ($20,900)
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Background: Why do we care?
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Background: Previous Studies
- Acute injuries
- 571 sports injuries in 1 year
- 28 sports
- 65% males
- 1.9 visits per injury
- Mean cost per injury $446
- Individual sports more costly
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Background: Previous Studies
- 12 million athletes ages 5-22 suffer sport-associated injury annually
- $33 billion in health care costs
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Background: Previous Studies
- 72 of 82 Belgium sports federations participated
- Main outcome: total direct and indirect medical cost on healthcare budget
- Highest direct medical cost ACL (1358 euros)
- Lowest for foot injuries (52 euros)
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Background: Previous Studies
- 119 injuries in 104 children over 1 year
- Sports v leisure time v PE
- Mean direct cost 131 +/- 213 euros
- Highest costs in upper extremity and
leisure time activities
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Background: Gap in Research
- Healthcare burden based on TYPE of injury in youth
Acute Overuse Concussion
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Purpose
- To determine if the effect of sport related injury
- n healthcare burden varies by injury type
(acute, overuse, concussion) in a clinical cohort
- f young athletes over 3 years.
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Methods & Study Design
- Cross-sectional longitudinal clinical cohort study
- Data collected 2018-2019 (planning for 3 yrs)
- 3 cohorts: acute, overuse, or concussion
- Ages 8-18 at time of enrollment
- Information gathered from EMR 6 months from time of
enrollment
- Data included age, gender, # of clinic visits, x-rays,
MRIs, & surgeries
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Methods & Study Design
EMR Data Collection Survey Data Collection
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Demographics: Emory Only
- Total # consented eligible at 6 months from enrollment: 233 subjets
- Males: 141 (61%)
- Females: 92 (39%)
- Avg age: 15 yo
Gender Acute Concussion Overuse Male 70 /105 (67%) 15 /32 (47%) 56 /96 (58%) Female 35 /105 (33%) 17 /32 (53%) 40 /96 (42%) Gender & injury type
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Preliminary Data: Emory Only
144 (92.9%)
Sports medicine visits within 6 months of enrollment by injury type
Injury Type Kruskal-Wallis Test N Median Mean Std Dev Minimum Maximum P value Acute 105 2 2 2 1 9 0.10 Concussion 32 3 3 2 1 9 Overuse 96 2 3 2 1 13 Injury Type Kruskal-Wallis Test N Median Mean Std Dev Minimum Maximum P value Acute 105 3 2 2 1 9 0.29 Concussion 32 3 3 2 1 9 Overuse 96 3 2 2 1 13
Total visits within 6 months of enrollment by injury type
The statistical power is low to detect a difference of this size
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Preliminary Data: Emory Only
Number of X-rays within 6 months of enrollment by injury type
29 (20%) 23 (15.9%)
Injury Type Kruskal-Wallis Test N Mean Minimum Maximum P value Acute 105 2 6 <.0001 Concussion 32 1 Overuse 96 1 6
Pairwise P values (Wilcoxon rank-sum test): Acute vs Concussion: P <.0001 Overuse vs Concussion: P <.0001 Acute vs Overuse: p= 0.0010
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Preliminary Data: Emory Only
144 (92.9%) 69 (47.6%) 76 (52.4%)
Rates of MRI tests per 1000 patients by injury type Acute Concussion Overuse Yes MRIs (>=1 ) 24/105 (22%) 229 MRIs per 1000 patients (95% CI: 146,340) 0/32 (0%) 0 MRIs per 1000 patients (95% CI: 0,115) 47/96 (49%) 490 MRIs for 1000 patients (95% CI: 360,651)
Rates were used to summarize the data due to the high number of zeros 95% confidence intervals do not overlap indicating the rates are different by injury type
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Preliminary Data: Emory Only
# of surgeries by injury type # of surgeries Acute Concussion Overuse 92/105 (87.62%) 32/32 (100%) 90/96 (93.75%) 1 13/105 (12.4%) 0/32 (0%) 5/96 (5.2%) 2 0/105 (0%) 0/32 (0%) 1/96 (1%)
Pairwise Fisher’s exact P value: Acute vs Concussion: P=0.04 Overuse vs Concussion: P =0.50 Acute vs Overuse p= 0.06
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Preliminary Conclusions
At 6 months post-enrollment:
- 1. There is no difference in number of clinic visits by injury type.
- 2. The rate of MRI per 1000 patients is different by injury type
(overuse>acute>concussion).
- 3. There are pairwise differences in the number of surgeries by injury type
(acute>concussion, acute>overuse).
- 4. There are pairwise differences in the median number of x-rays by injury
type (acute>concussion, overuse>concussion, acute>overuse).
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Limitations
- Analysis presented is preliminary data
- Risk for sampling bias
- Unable to capture outside resources used
- Cross sectional data and not yet longitudinal
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Clinical Significance
- Injury type affects rate of MRIs & surgeries in young athlete, but not
number of clinic visits.
- Acute injuries require more surgeries.
- Overuse injuries require more MRIs.
- Longitudinal data on healthcare burden by injury type may help guide
counseling young athletes & families on potential healthcare burden of each injury.
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