young athlete injury outcome study (ios): healthcare ...€¦ · grant funding • emory university...
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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, MD Site PI [Boston Children’s]: Dr. Andrea Stracciolini, MD
Site PI [Lurie Children’s]: Dr. Cynthia LaBella, MD
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DisclosuresI, Heather Saffel, have no relevant disclosures.
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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
OveruseConcussion
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Purpose• To determine if the effect of sport related injury
on healthcare burden varies by injury type (acute, overuse, concussion) in a clinical cohort of 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 OveruseMale 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 typeInjury Type Kruskal-Wallis Test
N Median Mean Std Dev Minimum Maximum P valueAcute 105 2 2 2 1 9 0.10
Concussion 32 3 3 2 1 9Overuse 96 2 3 2 1 13
Injury Type Kruskal-Wallis TestN Median Mean Std Dev Minimum Maximum P value
Acute 105 3 2 2 1 9 0.29Concussion 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 OnlyNumber of X-rays within 6 months of enrollment by injury type
29 (20%)
23 (15.9%)
Injury Type Kruskal-Wallis TestN Mean Minimum Maximum P value
Acute 105 2 0 6 <.0001Concussion 32 0 0 1
Overuse 96 1 0 6Pairwise P values (Wilcoxon rank-sum test): Acute vs Concussion: P <.0001Overuse vs Concussion: P <.0001Acute 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 OveruseYes 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 zeros95% 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 Overuse0 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=0.04Overuse vs Concussion: P =0.50Acute vs Overuse p= 0.06
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Preliminary ConclusionsAt 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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Questions?/Discussion