National estimates of nonurgent emergency department utilization for sportsrelated injuries in high school-age population
The study provides national estimates indicating that over half of emergency department visits for sports-related musculoskeletal injuries among high school-age patients are nonurgent. It finds that patients with public insurance and those from lower socioeconomic backgrounds are more likely to seek nonurgent care, suggesting potential for reducing such visits through athletic trainer services.
College of Health researcher(s)
Abstract
Context
Athletic trainers (ATs) can manage nonurgent, musculoskeletal emergency department (ED) visits. Little is known about what populations are most likely to use the ED for nonurgent, sports-related musculoskeletal injuries.
Objectives
Our object is to provide national-level evidence on whether high-school age population with public insurance or lower socioeconomic status were more likely to have ED visits for nonurgent injuries.
Design
Cross-sectional study.
Setting
Secondary data analysis of the 2017-2019 Nationwide Emergency Department Sample (NEDS).
Patients or Other Participants
ED visits for high school-age patients with a sports-related musculoskeletal injury.
Main Outcome Measure
We used a multi-step process and AT scope of care threshold to classify ED visits for musculoskeletal injuries as urgent and nonurgent. National estimates of the proportions of visit, patient, and hospital characteristics by urgent, nonurgent, and total injury ED visits were reported. Survey weighted logistic regression was used to calculate odds ratios of an ED visit being for a nonurgent injury based on a patient's insurance type and socioeconomic status.
Results
For ED visits for musculoskeletal injuries in a high school-age, sports exposed population, 52.93% (95% CI: 51.11, 54.73) were for nonurgent injuries. Patients with public insurance were more likely (OR = 1.39; 95% CI: 1.35, 1.44) to have an ED visit for a nonurgent injury compared to ED visits for patients with private insurance. Patients from the lowest estimated neighborhood income quartiles were more likely (OR = 1.10; 95% CI: 1.02, 1.20) to have an ED visit for a nonurgent injury compared to ED visits for patients in the highest estimated income quartile.
Conclusions
Our results suggest opportunities to reduce nonurgent ED use using AT services exist, especially in high school-age athletes from vulnerable populations.
FAQ: Nonurgent Emergency Department Use for Sports-Related Injuries in High School Students
What are the main findings of this study?
The study found that over half of sports-related musculoskeletal injury emergency department (ED) visits in high school students were for nonurgent injuries, potentially manageable by athletic trainers (ATs). Specifically:
- Public insurance: Students with public insurance were 39% more likely to visit the ED for nonurgent sports injuries compared to students with private insurance.
- Income: Students from the lowest income quartile were 10% more likely to have a nonurgent sports-related ED visit than those in the highest income quartile.
Why are ED visits for nonurgent injuries a concern?
Nonurgent ED visits strain the healthcare system and contribute to billions of dollars in avoidable spending annually. They are also more costly than alternative care settings like primary care offices or athletic training facilities.
How were nonurgent injuries defined in this study?
The study defined nonurgent injuries based on the "scope of care" of an athletic trainer. This included:
- Musculoskeletal injuries manageable by an AT without additional healthcare: Examples include minor sprains, strains, and contusions.
- Musculoskeletal injuries manageable by an AT with referral to another healthcare provider, but same-day care is not needed: Examples might include suspected but not confirmed fractures, certain types of concussions, or lacerations requiring stitches.
How did the researchers ensure that urgent injuries were not misclassified as nonurgent?
The researchers employed a multi-step process to ensure accurate classification:
- Expert review of ICD-10 codes: Experienced ATs reviewed lists of both nonurgent and urgent injury codes.
- CPT/HCPCS evaluation and management codes: These codes reflect the severity and complexity of the ED visit and were used to reclassify injuries as needed.
- Clinical Classification Software (CCS) codes: CCS codes group procedures into clinically significant categories, and codes indicating higher severity were used to reclassify injuries.
What factors might explain why students with public insurance and lower incomes are more likely to use the ED for nonurgent injuries?
- Lack of access to primary care: Medicaid patients and lower-income individuals often face barriers to accessing primary care, leading them to the ED for non-emergency conditions.
- Disparities in athletic trainer access: Lower-income schools and communities often lack adequate athletic training services, limiting injury prevention and management options for student-athletes.
How can athletic trainers help reduce nonurgent ED visits?
ATs can play a key role by providing:
- Injury prevention programs: Educating athletes and coaches about proper techniques and equipment can reduce the incidence of injuries.
- On-site injury assessment and management: Prompt care for minor injuries can prevent complications and the need for ED visits.
- Referral to appropriate healthcare providers: ATs can ensure athletes receive timely and appropriate care for more serious injuries.
What are the limitations of this study?
- Reliance on ICD-10 codes: While the researchers took steps to improve accuracy, relying solely on ICD-10 codes for clinical detail has inherent limitations.
- Lack of data on AT access: The study could not directly measure whether patients had access to an AT, potentially influencing their healthcare choices.
- Assumptions about AT practice: The study assumes ATs work to their full scope of practice, which may not always be possible due to factors like experience or resources.
What are the implications of this study for future research and practice?
- Quantify the costs of nonurgent ED visits: Further research should investigate the financial burden of nonurgent sports-related ED visits, particularly in vulnerable populations.
- Measure the impact of AT access: Research should directly evaluate the effects of AT services on healthcare utilization, costs, and patient outcomes.
- Address barriers to AT access: Expanding AT services, particularly in underserved communities and schools, is crucial to mitigate nonurgent ED use.
- Increase awareness of AT services: Educating patients, families, and other healthcare providers about the scope of AT practice can improve care coordination and reduce unnecessary ED utilization.