Value, 2008

University of Iowa College of Public Health

April 2008

Researchers at the University of Iowa College of Public Health used AHRQ's Nationwide Inpatient Sample (NIS), a database from the Healthcare Cost and Utilization Project (HCUP), for two studies on pediatric sports-related injuries. One study included all pediatric sports-related injuries requiring hospitalization; the other narrowed its focus to hospitalizations for sports-related concussion.

Findings from these studies will aid efforts to prevent sports-related injuries and reduce both costs and hospitalizations. This research is noteworthy because very little data currently exists about pediatric sports-related injury hospitalizations.

Lead investigator Jingzhen (Ginger) Yang, PhD, MPH, Assistant Professor, Department of Community and Behavioral Health, also works at the University of Iowa Injury Prevention Research Center. She learned about HCUP resources from a student in the Health Policy and Management Department.

"NIS data provides a great resource to us in understanding the characteristics of more severe injuries, as well as the economic burden associated with these injuries," Yang notes.

At least 4.3 million sports and recreational injury episodes occur each year in school-aged children in the U.S. Although the number of sports-related injuries requiring hospitalization is small compared with those treated in emergency departments or outpatient settings, these more serious injuries can have profound negative consequences in terms of physical and mental health. They can also place a tremendous financial burden on the patient's family and the health care system.

Yang and her colleagues first analyzed hospitalizations between 2000 and 2003 for patients aged 5 to 18 with a diagnosis of a sports-related injury in the NIS. During this period, there were approximately 10,000 sports injury hospitalizations per year for patients aged 5 to 18. The actual number of hospitalizations is probably higher, because many other such injuries may have diagnosis codes that do not specify the injury as being sports-related.

The annual hospital charges for the 10,000 hospitalizations were $113 to $133 million. These figures do not include other costs, such as professional fees, emergency transportation costs, and subsequent rehabilitation costs; therefore, the financial impact is significantly higher.

More than half of these injury hospitalizations were attributed to fractures, and approximately half were 15 to 18 years of age. Boys accounted for nearly 87 percent of the hospitalizations, or nearly six times the rate of girls' hospitalizations. The most frequently injured body sites, in order of occurrence, were the lower extremities, the head and neck, and the upper extremities.

The second study focused solely on nonfatal concussions. This is the first study using national data to estimate injury rates and economic consequences associated with pediatric sports-related concussion hospitalizations.

In the U.S., more than 300,000 sports-related traumatic brain injuries (TBIs) occur each year, and many of the injured are children. Between 2001 and 2005, children aged 5 to 18 accounted for nearly 135,000 sports-related TBIs that required emergency department visits, and about 18 percent of sports-related hospitalizations in this age group were attributed to TBIs. Older age, but not gender, was associated with increased odds of sports-related concussion hospitalizations.

The economic impact for sports-related concussion hospitalizations is significant, with hospital charges during the study period approaching $30 million. Again, this is just part of the true total cost—professional fees, emergency transportation costs, and subsequent rehabilitation costs are not included.

Though sports-related concussions may not directly lead to death, the impact on overall health and well-being can be substantial. Injury to a child's brain can have many long-lasting health outcomes, including chronic headaches, emotional liability, and memory deficits.

The NIS, the largest all-payer inpatient care database in the United States, contains data from approximately 8 million hospital stays from some 1,000 hospitals. The NIS is one in a family of databases, software tools, and products developed as part of HCUP. HCUP is a Federal-State-Industry partnership that brings together the data-collection efforts of many organizations—such as State data organizations, hospital associations, private data organizations, and the Federal government—to create a national information resource.

Impact Case Study Identifier: CDOM 08-03
AHRQ Product: Healthcare Cost & Utilization Project—Nationwide Inpatient Sample (HCUP-NIS)
Topic(s): Prevention, Pediatrics, Mental Health
Scope: Iowa

Yang J, Peek-Asa C, Allareddy V, Phillips G, Zhang Y, Cheng G. Patient and hospital characteristics associated with length of stay and hospital charges for pediatric sports-related injury hospitalizations in the United States, 2000-2003. Pediatrics 2007; 119:e813-820.

Yang J, Phillips G, Xiang H, Allareddy V, Heiden E, Peek-Asa C. Hospitalizations for sport-related concussions in U.S. children aged 5 to 18 years during 2000-2004. British Journal of Sports Medicine 2007; 10.1136.

HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2000-2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/nisoverview.jsp

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