Abstract
Healthcare utilization before and after concussion law among Medicaid-insured children: A comparison between sport and non-sport related concussions
Alison Newton, MPH1, Jingzhen Yang, PhD, MPH2, Lindsay Sullivan, PhD, MA3, Lihong Huang, PhD1, Bhavna Singichetti, MPH4, Motao Zhu, MD, MS, PhD3 and Ashley Felix, PhD, MPH5
(1)Nationwide Children's Hosptial, Columbus, OH, (2)Nationwide Children's Hospital/Ohio State University, Columbus, OH, (3)Nationwide Children’s Hospital, Columbus, OH, (4)Nationwide Children's Hospital, Columbus, OH, (5)The Ohio State University, Columbus
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
purpose: To evaluate patterns of health care utilization among sport related concussions (SRCs) and non-sport related concussions (NSRCs) among Medicaid-insured children before and after Ohio’s concussion law enacted April 2013.
methods: We analyzed claim data from Partners for Kids (PFK) Ohio Medicaid database from 2008-2017. We calculated the rates of healthcare utilization, along with95% confidence intervals, for SRCs and NSRCs among children (ages 0-18) from the pre-law to post-law. We used multinomial logistic regressions to assess the effect of the law on the type of healthcare utilization by SRCs and NSRCs.
results: Over the 9 year study period, a total of 10, 247 injuries (27.1% SRCs, and 72.9% NSRCs) sought healthcare for concussions. Among younger patients, the majority of healthcare utilization was for NSRCs. Among male patients, the majority of healthcare utilization was for SRCs. The annual rates of healthcare utilization for concussions increased from pre-law to immediate post-law, with similar trends observed in SRCs and NSRCs. During the post-law period, patients with SRC and NSRC were more likely to utilize Office/Clinic (OR= 1.52, 95% CI 1.39, 1.65 and OR=1.732 95%CI 1.64, 1.83, respectively) or Urgent Care (OR= 1.73, 95% CI 1.38, 2.18; OR=2.15 95%CI 1.79, 2.59, respectively) than ED, compared to pre-law.
conclusions: Increased healthcare utilization for concussions was observed post-law for both SRCs and NSRCs. Future studies should use national databases of pediatric populations to validate these findings.
Epidemiology Public health or related laws, regulations, standards, or guidelines Public health or related organizational policy, standards, or other guidelines
Abstract
Relationship between sports medicine staffing and injury in college athletics
Christine Baugh, MPH1, Laura Hatfield, PhD2 and Thomas McGuire, PhD2
(1)Harvard University, Cambridge, MA, (2)Harvard Medical School, Boston, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Understanding factors that influence injury rates in college sports may improve athlete health and well-being. Although sport-specific injury epidemiology is well understood, the effects of institutional features on athlete injury are not. Institutional features are important because they may be modified to reduce injury rates across sports and genders. The present study examines the relationship between a school’s number of sports medicine clinicians per athlete and its rates of athletic injury, reinjury, and time lost to injury. We study sports injury and participation data from 2009/10 to 2013/14 from the National Collegiate Athletic Association Injury Surveillance Program (NCAA ISP) and staffing data from NCAA Research. These data describe 25,203 injuries experienced by 12,296 college athletes during 144,389 games or practices at 141 NCAA member schools. We fit Poisson regression models to injury count and reinjury count (separately) at the school-sport-year level with an offset for exposure (sum of athlete-practices and -games) and controlling for sport, school, division of competition, and academic year. We find that injury and re-injury rates are lower when there are more clinicians per athlete (p<0.001). A zero-inflated Poisson regression of time lost to injury at the school-sport-year level—again controlling for sport, division of competition, and academic year—indicates that time loss is longer when there are more clinicians per athlete (p<0.001). The finding that school-level measures of clinicians per athlete are related to rates of injury, reinjury, and time lost to injury warrants future research into possible mechanisms.
Epidemiology Public health or related organizational policy, standards, or other guidelines Public health or related research
Abstract
Team size is associated with rates of injury in US high school boys’ football
Lauren A. Pierpoint, MS1, Michael Koester, MD2 and R. Dawn Comstock, PhD1
(1)Colorado School of Public Health, Aurora, CO, (2)Slocum Center for Orthopedics and Sports Medicine, Eugene, OR
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background:
Boys’ football continues to have the highest rate of injury out of all high school sports, especially for concussions, making identification of new areas for injury prevention crucial. We investigated team size as a potential risk factor associated with injury rates.
Methods:
Injury and athlete exposure (AE) information were collected from the High School Reporting Information online database from 2005/06-2016/17. Team size was estimated by summing AEs for each high school per season of participation. Smaller AEs per school-season indicates teams with fewer athletes. Negative binomial regression was used to calculate rate ratios (RRs) comparing small teams (10th AE percentile) to large teams (90th percentile), adjusting for year.
Results:
Overall, 33,989 injuries occurred during 8,343,129 AE (Rate=4.07/1,000AE) including 7,023 concussions (Rate=0.85/1,000AE). Rates were higher in small teams compared to large teams overall (RR=2.25, 95%CI=1.81-2.79), in practice (RR = 2.18, 95%CI=1.60-2.94), and in competition (RR=1.89, 95%CI=1.53-2.35). Concussions followed similar patterns overall (RR=2.35, 95%CI=1.85-3.00), in practice (RR= 1.55, 95%CI=1.08-2.23), and in competition (RR=2.29, 95%CI=1.77-2.97). Sensitivity analyses revealed similar significant results for teams in the 25th vs. 75th percentiles and the lower vs. upper 50th percentiles.
Conclusions:
Higher injury rates observed here may reflect increased time at risk for individual athletes on teams with fewer available players, possibly because larger roster sizes allow coaches to make substitutions during games and limit individual participation in contact practices. These findings have potential policy ramifications (e.g. competitive classifications based on roster size rather than school enrollment) if football participation numbers continue to decline.
Epidemiology
Abstract
Design and findings from the epidemiology study of concussions in Ivy League and Big Ten student-athletes
Douglas Wiebe, PhD1, Bernadette D'Alonzo, MPH1, Carolyn Campbell-McGovern2, Martha Cooper3, Douglas Smith, MD1 and Margot Putukian, MD, FACSM4
(1)University of Pennsylvania, Philadelphia, PA, (2)Ivy League, Princeton, (3)Big Ten-Ivy League Traumatic Brain Injury Research Collaboration, Champaign, IL, (4)Princeton University, Princeton, NJ
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background. In 2013, Ivy League and Big Ten universities launched a concussion surveillance system in male and female student athletes in all sports at 17 universities. We provide a report of the design and methods of this study, and findings.
Methods. Participating universities are all 8 Ivy League institutions and 9 institutions in the Big Ten – Ivy League Traumatic Brain Injury Research Collaboration. Athletic trainers identify athletes when they sustain a concussion. Data coordinators abstract clinical (including the presence of 22 symptoms) and demographic information from medical records, administer a short questionnaire, and monitor athletes for dates of return to activity, athletics, and academics. Equivalence of survival curves by gender was compared using the Peto test.
Results. 1,574 sport-related concussions were recorded during the 4 athletic seasons from 2013-2017, including 615 in women and 959 in men, and including athletes from 26 sports. Participation is estimated at >90%. The median number of symptoms reported was 7 (IQR=2-11) in women and 7 (IQR=2-10) in men. Restricting subjects to only women and men who played varsity basketball, for example, the median time to return to academics was 7 days for women and 4 for men (p=0.259), and return to full play was 13 days for women and 11 days for men (p=0.364).
Conclusion. This collaboration has produced a rich dataset of concussion cases and valuable opportunities to learn about the incidence of concussion, correlates of symptom severity, predictors of delay time to recovery, and the effect of rules changes on concussion.
Clinical medicine applied in public health Epidemiology Other professions or practice related to public health
Abstract
Epidemiology of injuries in middle school football, 2015-2017: The ACHIEVES (Advancing Healthcare Initiatives for Underserved Students) Project
Zachary Kerr, PhD, MPH1, Nelson Cortes2, Jatin Ambegaonkar2, Amanda Caswell2, Matt Prebble2, Kaitlin Romm2 and Shane Caswell2
(1)University of North Carolina at Chapel Hill, Chapel Hill, NC, (2)George Mason University, Manassas, VA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Purpose: Although data exists on injuries in youth football leagues, there is a dearth of recent data on injury incidence in middle school (MS) football. Updated injury incidence estimates can help drive the development of injury prevention strategies. This study described the epidemiology of injuries sustained in MS football during the 2015/16-2017/18 school years.
Methods: Data originated from 9 public MSs in Virginia during the 2015/16-2017/18 school years. Certified athletic trainers (ATs) collected injury and athlete-exposure (AE) data from school-sanctioned games and practices in boys’ football. Injury counts and rates per 1000AE were calculated. Injury rate ratios (IRR) with 95% confidence intervals (CI) compared rates between games and practices.
Results: Overall, 644 injuries were reported (rate=20.54/1000AE; 95%CI: 18.98-22.11). The injury rate was higher in competition than practice (36.19 vs. 17.97/1000AE; IRR=2.01; 95%CI: 1.69-2.40). Most injuries were to the head/face (competition: 20.6%; practice: 15.8%) and hand/wrist (competition: 18.8%; practice: 16.4%) and were diagnosed as contusions (competition: 30.9%; practice: 25.9%) and sprains (competition: 19.4%; practice: 12.6%). Competitions also had a large proportion of concussions (10.3%). Most injuries were due to contact (competition: 80.0%; practice: 66.9%).
Conclusion: Findings parallel those found in previous football-related research from MS and other sport settings. Rates in MS football were higher than those previously reported in high school and college. However, caution must be taken when interpreting findings in relation to other surveillance systems with varying methodologies. Still, the findings highlight the need for injury prevention strategies within MS football, particularly as related to contact-related mechanisms.
Epidemiology