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

DisclosuresI, Heather Saffel, have no relevant disclosures.

Grant Funding• Emory University Department of

Orthopaedics (2018)• Seed Grant ($2,500)

• American Medical Society for Sports Medicine (2019)

• Foundation Grant ($20,900)

Background: Why do we care?

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

Background: Previous Studies• 12 million athletes ages 5-22 suffer sport-associated injury annually

• $33 billion in health care costs

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)

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

Background: Gap in Research• Healthcare burden based on TYPE of injury in youth

Acute

OveruseConcussion

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.

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

Methods & Study Design EMR Data Collection Survey Data Collection

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

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

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

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

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

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).

Limitations• Analysis presented is preliminary data• Risk for sampling bias • Unable to capture outside resources used• Cross sectional data and not yet longitudinal

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.

Questions?/Discussion