Injury-related Emergency Department Visits Research Articles

256 Comparative Analysis of Emergency Department Visits for Breast Injuries Pre- and Post-COVID

OBJECTIVES/GOALS: Studies show a decrease in injury-related emergency department (ED) visitsduring COVID.There is a gap in the literature regarding the effect of the pandemic on breast injury-related ED visits. We aim to compare these visits pre- and post-COVID, and whether this subset reflects the same trends seen in overall injury-related ED visits. METHODS/STUDY POPULATION: A retrospective study of breast injuries was conducted between 2018 and 2022, using the National Electronic Injury Surveillance System. Patients were categorized into pre-COVID and post-COVID groups, for visits occurring before and after January 20, 2020. A total of 1077 breast injuries were stratified into pre-COVID (n = 444) and post-COVID (n = 633) groups. Clinical data on patient demographics, diagnosis, disposition, location, and alcohol use were collected. RESULTS/ANTICIPATED RESULTS: Mean age was significantly different: pre-COVID mean age was 37.29; post-COVID’s was 40.40 (p = 0.0338). >90% of patients were female (p = 0.4066). White patients accounted for 36.0% of pre-COVID visits and 47.2% of post-COVID; BIPOC patients were 32.88% and 31.75% respectively. There was significant difference between race and COVID groups (p = 0.0013). No significant differences were found when considering all diagnoses (p = 0.3841) or the top three diagnoses (other, contusions/abrasions, and burns/scald) (p = 0.6176). Incident location showed a weak evidence of association (α = 0.1), when including unrecorded data (p = 0.1365) and removing those entries (p = 0.0832). Alcohol use did not reveal a significant association (p = 0.2110). DISCUSSION/SIGNIFICANCE: There are more breast injuries reported post-COVID. No significant difference was identified in the types of injuries diagnosed, the location these injuries took place, and how these injuries were treated. However, the demographics (age, race) of patients seeking care were significantly different.

Injury-related emergency department use among people with intellectual and developmental disabilities insured by Medicaid from 2010 to 2016

ObjectivesData on non-fatal injuries and visits to the emergency department (ED) for injuries are not readily available. The objective of this paper is to describe injury-related ED visits for people...

Are there seasonal patterns for emergency department visits for head injuries in the USA? Findings from the National Electronic Injury Surveillance System-All Injury Program

IntroductionPrevious international research suggests that the incidence of head injuries may follow seasonal patterns. However, there is limited information about how the numbers and rates of head injuries, particularly sports-...

76 Injury-related Paediatric Emergency Department Visits during the First 2 Years of the COVID-19 Pandemic

Abstract Background The onset of the COVID-19 pandemic was associated with a decrease in injury-related paediatric emergency department (ED) visits. However, the longitudinal impact of COVID-19 on paediatric injury beyond the first 6 months of the pandemic is not well established. Objectives To quantify the impact of COVID-19 and associated public health measures on injury-related paediatric ED visits during the first two years of the pandemic and determine whether children of all ages were similarly affected. Design/Methods We conducted a longitudinal observational study of injury-related ED visits at a large paediatric tertiary care centre before and during the COVID-19 pandemic. We used negative binomial regression to assess the impact of the first two years of the pandemic (Year 1: March 2020-February 2021; Year 2: March 2021-February 2022) on the monthly incidence of injury-related ED visits and risk of hospitalization from injury. Secular time-trends and seasonality were accounted for by modelling the pre-pandemic trend using a 4-year historical control (April 2016-February 2020). In a secondary stratified analysis, changes in monthly incidence of injury-related ED visits were assessed by age group (0-4, 5-11, and 12-17 years). Results Of 458,799 ED visits during the 6-year study period, 21,644 (4.7%) were associated with injuries. The distribution of age categories, acuity of presentation, and frequency of hospitalization were similar between the pre-pandemic and pandemic periods (see Table below). Injury-related paediatric ED visits reached a low (−49%) in March 2020 (IRR 0.51, 95% CI 0.43-0.60), and a peak (+50%) in January 2021 (IRR 1.50, 95% CI 1.33-1.68) relative to historical controls (see Figure). All three confinement periods were associated with an initial reduction in injury-related ED visits and followed by a rapid increase in visits. Fluctuations in injury-related ED visits were found to differ between age groups. While there was evidence of no change among preschoolers 0-4 years old, there was a 52% reduction in visits at the onset of the pandemic in children ages 5-11 (RR 0.48, 95% CI 0.35-0.65) and an 87% reduction in children ages 12-17 (RR 0.13, 95% CI 0.06-0.23) followed by a surplus of cases among the 5- to 11-year-olds in January 2021 (+53%; RR 1.53, 95% CI 1.25-1.85) and March 2021 (+48%, RR 1.48, 95% CI 1.21-1.80). Conclusion The consequences of COVID-19 on paediatric injury extend far beyond the first few months of the pandemic. Understanding changes in the incidence of paediatric injury around confinement periods may assist in the development of injury prevention strategies.

Pediatric emergency department visits for pedestrian injuries in relation to the enactment of Complete Streets policy.

This study aimed to evaluate the rate of pediatric emergency department (ED) visits for pedestrian injuries in relation to the enactment of the Complete Streets policy. The National Complete Streets policies were codified by county and associated with each hospital's catchment area and date of enactment. Pedestrian injury-related ED visits were identified across 40 children's hospitals within the Pediatric Health Information System (PHIS) from 2004 to 2014. We calculated the proportion of the PHIS hospitals' catchment areas covered by any county policy. We used a generalized linear model to assess the impact of the proportion of the policy coverage on the rate of pedestrian injury-related ED visits. The proportion of the population covered by Complete Streets policies increased by 23.9%, and pedestrian injury rates at PHIS hospitals decreased by 29.8% during the study period. After controlling for years, pediatric ED visits for pedestrian injuries did not change with increases in the PHIS catchment population with enacted Complete Streets policies. After accounting for time trends, Complete Streets policy enactment was not related to observed changes in ED visits for pedestrian injuries at PHIS hospitals.

Injury-related emergency department visits and unplanned readmissions are associated with worse long-term mental and physical health

BackgroundThe risk factors for unplanned emergency department (ED) visits and readmission after injury and the impact of these unplanned visits on long-term outcomes are not well understood. We aim to: 1) describe the incidence of and risk factors for injury-related ED visits and unplanned readmissions following injury and, 2) explore the relationship between these unplanned visits and mental and physical health outcomes 6–12 months post-injury. MethodsTrauma patients with moderate-to-severe injury admitted to one of three Level-I trauma centers were asked to complete a phone survey to assess mental and physical health outcomes at 6–12 months. Patient reported data on injury-related ED visits and readmissions was collected. Multivariable regression analyses were performed controlling for sociodemographic and clinical variables to compare subgroups. ResultsOf 7,781 eligible patients, 4675 were contacted and 3,147 completed the survey and were included in the analysis. 194 (6.2%) reported an unplanned injury-related ED visit and 239 (7.6%) reported an injury-related readmission. Risk factors for injury-related ED visits included: younger age, Black race, a lower level of education, Medicaid insurance, baseline psychiatric or substance abuse disorder and penetrating mechanism. Risk factors for unplanned injury-related readmission included younger age, male sex, Medicaid insurance, substance abuse disorder, greater injury severity and penetrating mechanism of injury. Injury-related ED visits and readmissions were associated with significantly higher rates of PTSD, chronic pain and new injury-related functional limitations in addition to lower SF-12 mental and physical composite scores. ConclusionsInjury-related ED visits and unplanned readmissions are common after hospital discharge following treatment of moderate-severe injury and are associated with worse mental and physical health outcomes.

The Pattern of Injuries in the Emergency Room during the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has obviously caused a remarkable change in patients' emergency department (ED) visits; however, data from multicenter studies are lacking. We aimed to present a comprehensive analysis of injury-related ED visits in Republic of Korea before and during the COVID-19 pandemic. Data from 23 tertiary hospitals based on Emergency Department-based Injury In-depth Surveillance were used for this retrospective cross-sectional study. A total of 541,515 ED visits (age ≥ 20 years) between 1 January 2018 and 31 December 2020 were included, and the trend of injuries related to motor vehicular accidents, falls, self-harm and suicide, assault, and poisoning were compared between the pre-COVID-19 time period and during the COVID-19 pandemic. In the first year of the COVID-19 period, a decline in the number of ED visits was observed (41,275, 21%) compared to the previous year. Injuries caused by motor vehicles (36,332 in 2019 vs. 27,144 in 2020), falls and slips (61,286 in 2019 vs. 49,156 in 2020), assaults (10,528 in 2019 vs. 8067 in 2020), and poisonings (7859 in 2019 vs. 7167 in 2020) decreased, whereas self-harm and suicide (8917 in 2019 vs. 8911 in 2020) remained unchanged. The hospitalization (16.6% in 2019 vs. 18.8% in 2020) and ED mortality rate (0.6% in 2019 vs. 0.8% in 2020) also increased. The COVID-19 pandemic led to a decline in the overall number of trauma patients seeking medical care; however, the proportion of patients requiring hospitalization or intensive care unit admission increased, indicating more severe injuries among those who did seek care. Suicide attempt rates remained unchanged, highlighting the need for targeted care and support for vulnerable patients. During the pandemic, EDs had to continue to provide care to patients with medical emergencies unrelated to COVID-19, which requires a delicate and adaptable approach to ED operations. To manage the increased stress and workload caused by the pandemic, increased resources and support for healthcare workers were needed.

Injury-related emergency department use among assisted living residents with Alzheimer's disease and related dementias.

Injuries are a leading cause of emergency department (ED) visits among older adults, and individuals with Alzheimer's disease and related dementias (ADRD) may be at particular risk. We compared injury-related ED use among assisted living (AL) residents with and without ADRD and assessed differences in the risk of injury-related ED visits among individuals with ADRD residing in ALs with memory care designation versus general AL. Using Medicare claims, we identified a cohort of fee-for-service beneficiaries who lived in AL in 2018 and resided in one of 20 states with site-specific information on memory care designation (n=116,754). Outcomes included all injury-related ED visits and injury-related ED visits resulting in hospitalization in the calendar year 2018. We fit multilevel models of the association between ADRD and outcomes, adjusting for resident demographic characteristics and chronic conditions, license type characteristics, and AL characteristics, with random intercepts at the AL and license type levels. Among residents with ADRD, we examined whether memory care licensure was associated with injury-related ED visits. The adjusted risk of injury-related ED use during the year was 20.1% (95% CI: 19.6%, 20.6%) for residents with ADRD compared to 16.1% for residents without ADRD (95% CI: 15.7%, 16.5%; p < 0.001). The adjusted risk of injury-related ED use ending in hospitalization was 4.9% (95% CI: 4.6%, 5.1%) for AL residents with ADRD and 3.9% for residents without ADRD (95% CI: 3.8%, 4.1%; p < 0.001). There were no significant differences in injury-related ED visits between residents with ADRD in ALs with memory care designation and residents in general AL. Injury-related ED visits are common among AL residents with ADRD and residents in memory care, but residents in memory care AL experienced similar risks of injury as those in general AL. Further research should identify modifiable factors that can prevent injury among AL residents with ADRD.

DUAL ELIGIBILITY AND INJURY-RELATED EMERGENCY DEPARTMENT VISITS AMONG ASSISTED LIVING RESIDENTS

Abstract Using 2018 Medicare data, we examined the relationship between dual eligibility and injury-related emergency department use among a cohort of assisted living residents (n=116,754). We fit multilevel models with random intercepts at the assisted living community and license type levels. The baseline rate of injury-related emergency department emergency department use was 0.17. After controlling for resident characteristics (i.e., age, sex, race, and chronic conditions), license type characteristics (i.e., dementia care licensure, staffing regulations), and assisted living community characteristics (i.e., size and percentage of residents with dementia), being dually eligible for Medicare and Medicaid was associated with a 12% increase in the probability of having an injury-related emergency department visit (b=.02; p&amp;lt;.001). Assisted living communities that serve duals may have fewer resources and staff to provide personal care, potentially leading to increased rates of injuries.

The association between vacant housing demolition and safety and health in Baltimore, MD

We measured the association between vacant housing demolitions and changes in crime and emergency department (ED) visits in Baltimore, MD. We included 646 block groups in Baltimore, 224 of which experienced at least one demolition from 2012 to 2019. The exposure was the number of demolitions completed in a block group during the previous quarter. Crime (all, property, and violent) and ED visits (all, adults, children, and for specific causes) were examined as the change in the rate per 1000 people from the previous quarter to the current quarter and analyzed using multivariable mixed effects regression models. Demolitions were associated with a small decrease in total ED visits (difference = −0.068 per 1000 people from the previous quarter to the current quarter, 95% CI -0.119, −0.018) but no significant change in crime. For each demolition, the rate of total child ED visits was 0.452 lower compared to the previous quarter (95% CI -0.777, −0.127). Demolitions were associated with small decreases in adult injury-related ED visits in the short term.

Risk of pre-existing hyponatremia and mortality in patients with traumatic brain injury across age groups

Traumatic brain injurySodiumClinical outcomes.

SPORTS AND RECREATIONAL ACTIVITIES RELATED INJURIES IN CHILDREN AND ADOLESCENTS IN KENYA

Purpose: Injuries sustained during sports or recreational activities have received more widespread attention in recent years due in part to interest in injury monitoring and prevention and rising rates of traumatic brain injury-related emergency department visits. Although exposure to sports offers many health benefits, participating in sports also increases risk of injury. The general objective of the study was to understand perception of sports and recreational activities related injuries in children and adolescents in Kenya.&#x0D; Methodology: The paper used a desk study review methodology where relevant empirical literature was reviewed to identify main themes and to extract knowledge gaps.&#x0D; Findings: Injury is an important child health problem that requires adequate attention and funding. Policies, surgical capacity building, and health systems strengthening efforts are necessary to address the high burden of pediatric injuries in Kenya.&#x0D; Unique Contribution to Theory and Practice: Safety guidelines, protective equipment and prevention education are crucial to reducing pediatric recreational and sports injuries. Preventing injuries and ensuring safe athletic practices are necessary for children and adolescents to continue to receive benefits from organized sports and recreational activities. Efforts to minimize these injuries are warranted both to ensure the long-term health of children and to reduce medical costs

Injury-Related Emergency Department Visits During the COVID-19 Pandemic

IntroductionOn March 13, 2020, the U.S. declared COVID-19 to be a national emergency. As communities adopted mitigation strategies, there were potential changes in the trends of injuries treated in emergency department. This study provides national estimates of injury-related emergency department visits in the U.S. before and during the pandemic.MethodsA secondary retrospective cohort study was conducted using trained, on-site hospital coders collecting data for injury-related emergency department cases from medical records from a nationally representative sample of 66 U.S. hospital emergency departments. Injury emergency department visit estimates in the year before the pandemic (January 1, 2019–December 31, 2019) were compared with estimates of the year of pandemic declaration (January 1, 2020–December 31, 2020) for overall nonfatal injury-related emergency department visits, motor vehicle, falls-related, self-harm-, assault-related, and poisoning-related emergency department visits.ResultsThere was an estimated 1.7 million (25%) decrease in nonfatal injury-related emergency department visits during April through June 2020 compared with those of the same timeframe in 2019. Similar decreases were observed for emergency department visits because of motor vehicle‒related injuries (199,329; 23.3%) and falls-related injuries (497,971; 25.1%). Monthly 2020 estimates remained relatively in line with 2019 estimates for self-harm‒, assault-, and poisoning-related emergency department visits.ConclusionsThese findings provide updates for clinical and public health practitioners on the changing profile of injury-related emergency department visits during the COVID-19 pandemic. Understanding the short- and long-term impacts of the pandemic is important to preventing future injuries.

Predictors of fall-related injuries due to common consumer products among elderly adult emergency department visits in the United States during 2007–2017

Falls are the leading cause of injuries and death among the elderly in the United States (U.S.). This study examined unintentional fall related-injuries and potential associations between various consumer products. Data was analyzed from the National Electronic Injury Surveillance System (NEISS) of hospital emergency department (ED) visits for unintentional injuries among the elderly between 2007 and 2017. Multiple logistic regression was used to examine the association between consumer products and fall-related injury ED visits. A total of 537,703 injury-related ED visits were analyzed. Two-thirds of visits were fall-related. Of those, 33% were among those 85 years and older, 62.5% occurred at home, 37.6% had head trauma, and 28.7% resulted in hospitalization. Flooring materials accounted for 29.1% of injuries. Ladders were significantly associated with fall-related injuries (adjusted odds ratio [AOR] 5.48, 95% confidence interval [CI] 4.72–6.36), followed by flooring materials (AOR 3.09, 95% CI 2.60–3.67), and porches and balconies (AOR 2.61, 95% CI 2.30–2.96). Several common consumer products are associated with fall-related injuries among the elderly. Increased awareness and education are critical.

State-Level Numbers and Rates of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths by Sex, 2014

To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by sex for 2014. Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states. Cross-sectional. Number and rate of TBI-related ED visits, hospitalizations, and deaths (indicators) by sex in over 25 states. Across all states that supplied data, males had higher rates of TBI-related ED visits, hospitalizations, and deaths than females. However, for some indicators, high rates for both sexes and low rates for both sexes appeared clustered in a specific region of the United States. There was also within-state variability in TBI rates by indicator and sex. For example, within-state variability between sexes ranged from as low as 2.8% for ED visits and as high as 335% for deaths. TBI-related ED visits, hospitalizations, and deaths varied by state and by sex, and evidence was found for within-state variability in TBI rates by indicator and sex in 2014. Differences in TBI indicators by sex may have important implications for public health professionals implementing TBI prevention and care strategies at the state level.

State-Level Numbers and Rates of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths by Age, 2014.

To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by age group for 2014. Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states. Cross-sectional. Number and population-based incidence rates of TBI-related ED visits, hospitalizations, and deaths by age group-children and young adults (0-24 years), adults (25-64 years), and older adults (≥65 years)-in 36 states. South Dakota had the lowest rates of TBI-related ED visits for all age groups-children and young adults: 566.2 (95% CI: 539.2-593.3) per 100 000; adults: 269.2 (95% CI: 253.0-285.4) per 100 000; and older adults: 324.3 (95% CI: 293.4-355.2) per 100 000. Rhode Island had the lowest rate of TBI-related hospitalizations for children and young adults-25.9 (95% CI: 20.7-32.0) per 100 000. The lowest rate of TBI-related hospitalizations among adults and older adults was in Virginia-39.6 (95% CI: 37.7-41.4) per 100 000-and Ohio-129.3 (95% CI: 124.0-134.6) per 100 000-respectively. Maryland had the lowest rate of TBI-related deaths for children and young adults-3.1 (95% CI: 2.3-3.9) per 100 000. Rhode Island had the lowest rate of TBI-related deaths for adults-7.2 (95% CI: 5.2-9.8) per 100 000-and New Jersey had the lowest rate of TBI-related deaths for older adults-29.4 (95% CI: 26.5-32.4) per 100 000. This analysis demonstrated that there are variations in TBI-related ED visits, hospitalizations, and deaths by age. State public health professionals may use these findings to develop state-based strategies to address TBI.

Injuries in the time of COVID-19

Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.

Traumatic Brain Injury-Related Emergency Department Visits Among American Indian and Alaska Native Persons-National Patient Information Reporting System, 2005-2014.

The American Indian/Alaska Native (AI/AN) population has a disproportionately high rate of traumatic brain injuries (TBIs). However, there is little known about incidence and common mechanisms of injury among AI/AN persons who seek care in an Indian Health Service (IHS) or tribally managed facility. Using the IHS National Patient Information Reporting System, we assessed the incidence of TBI-related emergency department visits among AI/AN children and adults seen in IHS or tribally managed facilities over a 10-year period (2005-2014). There were 44 918 TBI-related emergency department visits during the study period. Males and persons aged 18 to 34 years and 75 years and older had the highest rates of TBI-related emergency department visits. Unintentional falls and assaults contributed to the highest number and proportion of TBI-related emergency department visits. The number and age-adjusted rate of emergency department visits for TBI were highest among persons living in the Southwest and Northern Plains when compared with other IHS regions. Thousands of AI/AN children and adults are seen each year in emergency departments for TBI and the numbers increased over the 10-year period examined. Evidence-based interventions to prevent TBI-related emergency department visits, such as programs to reduce the risk for older adult falls and assault, are warranted.

LO51: Emergency department use by pregnant women: a population-based study within a universal healthcare system

Introduction: Emergency Department (ED) utilization during pregnancy may be common, but data specific to universal healthcare systems like Canada are lacking, where pregnancy care is supposed to be standardized. The objective of this study was to quantify and characterize ED utilization among all Ontarian women who had a recognized pregnancy, including by trimester and within 42 days after pregnancy, and further stratified by pregnancy outcome. Methods: Utilizing provincial administrative health databases, this retrospective population-based cohort study included all recognized pregnancies in Ontario conceived between April 1, 2002 and March 31, 2017. Peri-pregnancy ED utilization was defined as any ED visit from 0-42 weeks’ gestation, or within 42 days after the end of pregnancy. Modified Poisson regression was used to generate relative risks (RR) and 95% confidence intervals (CI) for the outcome of any peri-pregnancy ED utilization in association with maternal characteristics. Results: Peri-pregnancy ED utilization occurred among 1,075,991 of 2,728,236 recognized pregnancies (39.4%), including among 35.8% of livebirths, 47.3% of stillbirths, 73.7% of miscarriages, and 84.8% of threatened abortions. There were 22,802 (0.84%) ectopic pregnancies among all pregnancies in the cohort. ED utilization peaked in the first trimester and in the first week postpartum. A dose-response effect was seen in the number of peri-pregnancy ED visits in relation to certain maternal characteristics. Women residing in rural areas had an odds ratio (OR) of 3.44 (95% CI 3.39 to 3.49) for ≥ 3 ED visits, compared to those in urban areas. Women with 3-5 (OR 1.99 95% CI 1.97-2.01), 5-6 (OR 3.55, 95% CI 3.49 to 3.61), or ≥ 7 (OR 7.59, 95% CI 7.39 to 7.78) pre-pregnancy comorbidities were more likely to have ≥ 3 peri-pregnancy ED visits than those with 0-2 comorbidities. Of all recognized pregnancies in the cohort, only 106,989 (3.9%) had an injury-related ED visit. Conclusion: Peri-pregnancy ED utilization occurs in nearly 40% of pregnancies, notably in the first trimester and immediately postpartum. Efforts are needed to streamline rapid access to ambulatory obstetrical care during these peak periods, when women are vulnerable to either a miscarriage, or a complication after a livebirth.

The impact of Medicaid expansion on trauma-related emergency department utilization: A national evaluation of policy implications.

The impact of the 2014 Affordable Care Act (ACA) upon national trauma-related emergency department (ED) utilization is unknown. We assessed ACA-related changes in ED use and payer mix, hypothesizing that post-ACA ED visits would decline and Medicaid coverage would increase disproportionately in regions of widespread policy adoption. We queried the National Emergency Department Sample (NEDS) for those with a primary trauma diagnosis, aged 18 to 64. Comparing pre-ACA (2012) to post-ACA (10/2014 to 09/2015), primary outcomes were change in ED visits and payer status; secondary outcomes were change in costs, discharge disposition and inpatient length of stay. Univariate and multivariate analyses were performed, including difference-in-differences analyses. We compared changes in ED trauma visits by payer in the West (91% in a Medicaid expansion state) versus the South (12%). Among 21.2 million trauma-related ED visits, there was a 13.3% decrease post-ACA. Overall, there was a 7.2% decrease in uninsured ED visits (25.5% vs. 18.3%, p < 0.001) and a 6.6% increase in Medicaid coverage (17.6% vs. 24.2%, p < 0.001). Trauma patients had 40% increased odds of having Medicaid post-ACA (vs. pre-ACA: aOR 1.40, p < 0.001). Patients in the West had 31% greater odds of having Medicaid (vs. South: aOR 1.31, p < 0.001). The post-ACA increase in Medicaid was greater in the West (vs. South: aOR 1.60, p < 0.001). Post-ACA, inpatients were more likely to have Medicaid (vs. ED discharge: aOR 1.20, p < 0.001) and there was a 25% increase in inpatient discharge to rehabilitation (aOR 1.24, p < 0.001). Post-ACA, there was a significant increase in insured trauma patients and a decrease in injury-related ED visits, possibly resulting from access to other outpatient services. Ensuring sustainability of expanded coverage will benefit injured patients and trauma systems. Economic, level III.