Utilization of Emergency Department Services

Abstract

PURPOSE: The primary aim of this study is to compare utilization of ED services in Maine between students in areas of public high schools with certified athletic trainers (AT) and those without by looking at three common athletic injuries in the high school population of teens aged 14-18. METHODS: Using 2013 Maine All Claims data, we obtained aggregated counts of ED visits categorized by zip code for three injuries (ankle sprain, concussion, and fracture) based on their respective diagnosis codes. Each zip code was attributed to a high school in Maine. Each high school was contacted directly to determine AT status, number of students, number of athletes, and types of sports. We then calculated the rates of each of the three types of ED visits in schools with and without AT. Chi-square tests were used to compare the ED utilization for each type of injury among high schools with and without ATs. RESULTS: The 2013 Maine All Claims Data includes injury data for 346 Maine zip codes. There were a total of 1114 fractures, 826 sprains, and 538 concussions. Preliminary results were obtained from 185 (53.5%) zip codes, representing a total of 620 (55.6%) fractures, 427 (51.7%) sprains, and 305 (56.7%) concussions. These 185 zip codes represent 31992 students, 56.2% of the estimated 56,924 public high school student population in 2013-2014. In HS w/ AT, the cumulative student population was 28270 and there were 536 fractures, 339 ankle sprains, and 266 concussions. In HS w/o AT the cumulative student population was 3722 and there were 84 fractures, 88 ankle sprains, and 39 concussions. Rates were calculated by injury type per student population for schools w/ and w/o AT and reported per 100 person-time units. Fractures had rates of 1.90 and 2.26 for HS w/ AT and HS w/o AT, respectively, with a p value of 0.1423. Sprains had rates of 1.20 and 2.37 for HS w/ AT and HS w/o AT, respectively, with a p value of <0.0001. Concussions had rates of 0.94 and 1.05 for HS w/ AT and HS w/o AT, respectively, with a p value of 0.5223. CONCLUSION: Although data analysis is not yet complete, our preliminary investigation reveals a significant difference in the rates of utilization of ED services for sprains when comparing schools with and without ATs. There was no statistically significant difference found for similar comparisons of fractures and concussions.