Patient, Treatment, and Cost Characteristics Associated with Sport-Related Ankle Sprains: A Report from the Athletic Training Practice-Based Research Network
Marshall AN, Kikugawa TM, Lam KC. Athletic Training & Sports Health Care. 2019; Epub ahead of print. doi:10.3928/19425864-20190521-01
https://doi.org/10.3928/19425864-20190521-01
Take Home Message
On average a high school athlete is treated by an athletic trainer for 3 weeks after an ankle sprain with a total cost of $534, which is less than half the cost of an emergency room visit. Athletic trainers in this setting may consider using more rehabilitation and neuromuscular control interventions to reduce the long-term impact of ankle sprains.
Summary
Although ankle sprains are one of the most common lower limb injuries, there is little information about the services provided by athletic trainers and associated costs throughout the entire duration of care for high school athletes. Patient electronic medical records allow an athletic trainer to document all services provided and can provide much more information about a patient and care. We need to know the treatment strategy and estimated direct costs of care provided by athletic trainers to describe and quantify the value of the care they provide to athletes. Therefore, the authors used pre-collected CORE-AT electronic medical records from within the Athletic Training Practice-Based Research Network to provide details on patients, treatments, and costs of an ankle sprain as documented by athletic trainers in secondary school settings. The Network included 9 years of data (2009 to 2017) from secondary schools in 11 states. The authors included all types of ankle sprains if there was complete documentation from the initial injury until discharge of care, a description of a patient’s age, sex, sport, activity during injury, mechanism, and type of ankle sprain. The authors assessed length of care. They also used the Centers for Medicare and Medicaid Services Physician Fee Schedule to calculate the average cost per modality, rehabilitation, taping/bracing, or other intervention per ankle sprain case. The authors included 130 full ankle sprain cases (60% male), which an athletic trainer primarily documented as ankle sprain/strains (82%) that occurred during contact or twisting mechanisms (75%), and during contact field and court sports (75%). The average athlete received care for ~22 days, including 18 treatment services with a total cost of $534 ($71/visit, ~2 services/visit; see Figure). The most common treatment types were hot/cold packs (23%), therapeutic exercise (22%), re-evaluation (17%), and strapping (9%).
Viewpoints
The authors illustrate the importance of having an athletic trainer in a secondary school setting to potentially reduce health care costs associated with ankle sprain injuries. The authors noted that a single emergency department visit for an ankle sprain typically costs about $1,200. This cost is about double the average cost for services provided over the entire treatment timeline of about 3 weeks. Although most patients after an ankle sprain never seek care and “walk it off”, this neglect can lead to long-term disability and future costs. Meanwhile, treatment interventions can successfully improve ankle sprain outcomes for a patient. Athletic trainers may share this information with administrators or other third-party individuals to educate them on the benefit of employing an athletic trainer in these settings. Furthermore, the authors showed that secondary school athletic trainers are following recommended ankle sprain interventions; however, few athletic trainers included evidence-based interventions (e.g., therapeutic exercise interventions, strapping, neuromuscular education). The NATA position statement on ankle sprains highlights the importance of these approaches for treatment and prevention of ankle injuries and long-term disability in athletes. Overall, we need to promote the use of these evidence-based treatment strategies to reduce injury burden after an ankle sprain. Furthermore, clinicians and administrators can use these findings to highlight that athletic trainers may reduce health care costs for ankle injuries in the secondary school setting.
Questions for Discussion
What types of interventions do you use for athletes with ankle sprains to reduce long-term injury burden? What other types of injuries do you think would be important to investigate in terms of treatment and costs from initial injury through to discharge besides ankle sprains? How do you think we can leverage this information to positively influence policy changes in the secondary school setting for hiring or maintaining athletic trainers?
Written by: Alexandra F. DeJong
Reviewed by: Jeffrey Driban
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Being a student, and moving from clinical site to site each semester, I’ve seen a wide range of measures taken for ankle sprains ranging from preventative measures such as supplying athletes with ankle braces regardless of injury history as well as using NSAIDs, in conjunction to ICE early in rehab with a focus in balance and strength once rehab exercises begin. Playing volleyball throughout undergrad, I believe that looking at rotator cuff injuries for the overhead athlete might be beneficial in a similar way that this information could be for ankle sprains. Lastly, I believe showing how the AT is saving the school as well as athletes/parents money and actually putting a number behind the work we do would help get the ball rolling on policy changes in that regard.
Hi Michael,
Thanks for interacting with this post! This is great information to share, and I certainly agree that looking at the care for some of the more common injuries by sporting demands would be very important for understanding the role Athletic Trainers and other health care professionals play to advocate for policy changes.
I found this information to be very interesting, and that it could be useful in many ways. First, like mentioned, I think that this information could be helpful in showing administration in schools why having an athletic trainer could be beneficial, and could help one save money. Considering that this statistic includes actual numbers, and not just the generalized statement that “you will save money”, I think this helps to make a more-convincing argument (lets be honest, people like numbers and to ability to see the actual amount of money they could save).
Further, I think that this would be good information to provide to parents in the secondary setting. Often, when working as a student in the secondary school setting, and even as a former secondary setting athlete myself, I do not think parents/athletes realize how much knowledge that an athletic trainer has. By knowing that their child could get optimal care, at a much cheaper price, I think that more student-athletes would be apt to use this service. Also, this service would be available right on school campus, which would create an ease of use for the parents for the continued care (for ex: the parents do not have to take days off work to drive their child to an appointment). I think that once more parents become “on- board” with this idea, it will help to validate athletic trainer’s importance to administration much more.
Hi Hannah,
Thanks so much for the response! Yes, I completely agree with your post; the more information we can disseminate to important stakeholders, the more likely it will be that Athletic Trainers get buy-in and recognition for their role in secondary schools.
I found this article to be extremely useful and helpful in understanding how important athletic trainers are to schools and saving athlete’s money when it comes to athletic health care. While reading the article, I was thinking about how this study may apply to the college setting. I have been in many college clinical sites and it seems that I am doing rehabilitation with an ankle sprain almost every single day. I think that it would also be interesting to do a similar study while looking possible hamstring injuries in the secondary/college setting and see the cost related to rehabilitation and treatment of these common injuries in running sports.
I am a currently an AT student with a clinical site at a secondary school. Although my site is not like most secondary schools, our ATR is within a physical therapy clinic attached to the school. Every day there is a PT on site and in addition at football games we have a team doctor/EMT. My preceptor is very knowledgeable about the high school population and we are very fortunate with the equipment and personnel in comparison to most secondary schools. Our protocol in an ankle sprain situation is RICE and send athlete home with the parents explaining our findings and instructing the parents on how to continue care for the athlete whether it is seeing one of our team doctors if there is enough evidence to get a second look or giving the patient Ibuprofen or NSAIDS. When an athlete feels particularly uncomfortable, we may look into putting a horseshoe pad around both malleoli to keep effusion out of the joint.
Aside from ankle injuries, we see a decent number of ACL injuries in the secondary school setting. Younger female athletes are already at a higher risk than their male counterparts. I think that as long as we have the tools to strengthen our female athletes; we have a better chance of keeping more numbers on the fields.
I believe that a lot of high school athletic trainers are fresh college graduates with little to no experience in the field. Most secondary school settings have only one AT on site and little to no extra help with facilities or equipment because we do not have as many lobbyists fighting for us in comparison to other fields. If seasoned athletic trainers were at the youngest level of athletics alone rather than first job athletic trainers, the athletes may have a better chance of success especially when it comes to something as minor or major as an ankle sprain. I also believe that there should be an athletic trainer at every athletic setting to reduce long term injury and keeping more money in the parents pockets not going to an urgent care/emergency room.