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Open Access

Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)

Ophelie Lavoie-Gagne, Matthew Siow, William E Harkin, Alec R Flores, Carey S Politzer, Brendon C Mitchell, Paul J Girard, Alexandra K Schwartz, William T Kent
DOI: 10.1136/tsaco-2020-000634 Published 22 January 2021
Ophelie Lavoie-Gagne
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Matthew Siow
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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William E Harkin
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Alec R Flores
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Carey S Politzer
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Brendon C Mitchell
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Paul J Girard
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Alexandra K Schwartz
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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William T Kent
Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Article Figures & Data

Tables

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  • Table 1

    Patientcharacteristics and clinical course

    All injuries
    (n=63)
    Orthopedic injury
    (n=18)
    Facial injury
    (n=30)
    Cranial injury
    (n=15)
    P values
    Patient demographics
    Age (years)40.19±13.2941.83±15.5240.73±12.5637.13±12.210.69
    Male, n (%)42 (66.7)12 (66.7)23 (76.7)7 (46.7)0.14
    Out-of-town visitor, n (%)2 (3.2)0 (0.0)1 (3.3)1 (6.7)0.56
    Injury context
    Motor vehicle involvement, n (%)16 (25.4)7 (38.9)4 (13.3)5 (33.3)0.11
    Helmet use, n (%)2 (3.2)2 (11.1)0 (0.0)0 (0.0)0.08
    Any intoxication, n (%)*37 (58.7)6 (33.3)23 (76.7)8 (53.3) 0.01
    Positive BAL, n (%)†34 (54.0)5 (27.8)21 (70.0)8 (53.3) 0.02
    Positive urine toxicology, n (%)11 (17.5)2 (11.1)9 (30.0)0 (0.0) 0.03
    Clinical course
    BIBA, n (%)‡50 (79.4)14 (77.8)24 (80.0)12 (80.0)0.98
    Surgery, n (%)18 (28.6)5 (27.8)11 (36.7)2 (13.3)0.20
    Length of stay (days)3.90±8.726.61±14.562.27±2.693.93±7.030.18
    • P-values <0.05 bolded.

    • *Intoxication defined as defined by clinical evaluation, positive BAL or urine toxicology.

    • †BAL >11 mmol/L.

    • ‡Patient brought in by ambulance (BIBA).

    • BAL, blood alcohol level.

  • Table 2

    Injuries, radioimaging and subspecialty consultations

    All injuries
    (n=63)
    Orthopedic
    (n=18)
    Facial
    (n=30)
    Cranial
    (n=15)
    P values
    Injuries
    ISS8.79±4.637.67±4.068.77±3.4010.20±6.860.40
    Concussion, n (%)7 (11.1)0 (0.0)1 (3.3)6 (40.0) <0.001
    Intracranial bleed, n (%)*7 (11.1)0 (0.0)0 (0.0)7 (46.7) <0.001
    TBI, n (%)2 (3.2)0 (0.0)0 (0.0)2 (13.3) 0.04
    Any fracture, n (%)38 (60.3)12 (66.7)23 (76.7)3 (20.0) 0.001
    Lower extremity fracture6 (9.5)6 (33.3)0 (0.0)0 (0.0) <0.001
    Upper extremity fracture4 (6.3)3 (16.7)1 (3.3)0 (0.0)0.10
    Facial fracture27 (42.9)1 (5.6)23 (76.7)3 (20.0) <0.001
    Spine or rib fracture2 (3.2)2 (11.1)0 (0.0)0 (0.0)0.08
    Radioimaging
    Any X-ray38 (6.3)16 (88.9)15 (50.0)7 (46.7) 0.01
    Any non-contrast CT61 (96.8)18 (100.0)30 (100.0)13 (86.7) 0.04
    Any contrast CT10 (15.9)2 (11.1)3 (10.0)5 (33.3)0.12
    Any MRI2 (3.2)1 (5.6)0 (0.0)1 (6.7)0.39
    Subspecialty consultation
    Total number of consults1.63±0.971.67±1.191.57±0.821.73±1.030.90
    Trauma, n (%)47 (74.6)13 (72.2)22 (73.3)12 (80.0)0.86
    Orthopedic trauma, n (%)8 (12.7)8 (44.4)0 (0.0)0 (0.0) <0.001
    Otolaryngology, n (%)21 (33.3)1 (5.6)15 (50.0)5 (33.3) 0.007
    Ophthalmology, n (%)18 (28.6)2 (11.1)14 (46.7)2 (13.3) 0.01
    Neurosurgery, n (%)14 (22.2)1 (5.6)4 (13.3)9 (60.0) <0.001
    Orthopedic hand, n (%)7 (11.1)6 (33.3)1 (3.3)0 (0.0) 0.002
    Plastics, n (%)10 (15.9)2 (11.1)7 (23.3)1 (6.7)0.29
    Orthopedic spine, n (%)2 (3.2)1 (5.6)1 (3.3)0 (0.0)0.67
    • *Intracranial head bleeds including subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematoma, epidural hematoma, and intraventricular hemorrhage.

    • ISS, Injury Severity Score; TBI, traumatic brain injury.

  • Table 3

    Healthcare encounter cost

    All injuriesOrthopedicFacialCranialP values
    Total hospital charges to insurance$86 376±$125 438$97 562±$138 163$65 408±$50 818$122 136±$211 5740.39
    Total professional charges to insurance$9334±$14 711$13 691±$21 773$5784±$4015$12 103±$18 5770.17
    Total billing for encounter$95 710±$138 215$111 253±$158 031$71 192±$54 027$134 239±$228 5010.37
  • Table 4

    Total billing associated with specific patient characteristics

    Without variableWith variableP value
    Patient demographics
    Male$83 932±$76 184$101 146±$159 5610.52
    Age (years)
     <40$74 472±$57 566$116 215±$184 7291.00
     40–64$110 436±$176 614$76 861±$60 2080.67
     >64$97 996±$141 640$54 566±$23 8880.34
    Out-of-town visitor*$97 644±$140 365$42 538±$4860.27
    Motor vehicle involvement$90 058±$123 940$116 906±$187 5860.09
    Helmet use$97126±$140 459$56 760±$35 8980.59
    Any intoxication†$69 558±$47 148$110 965±$169 2500.97
    Positive BAL‡$92 917±$128 932$97 741±$146 5360.83
    Positive urine toxicology$92 724±$127 266$108 198±$184 0680.58
    BIBA§$116 214±$232 187$88 304±$103 7600.20
    Clinical course
    Number of consultations
     0–2$224 165±$306 098$71 625±$55 326 0.03
     >2$71 625±$55 326$224 165±$306 098 0.03
    Injuries
    ISS
     0–5$110 105±$157 562$55 404±$36 708 0.01
     6–9$111 547±$177 735$76 828±$64 8250.78
     10–14$85 095±$106 651$128 314±$209 823 0.05
     >14$84 091±$116 853$415 245±$347 573 0.03
    Concussion$70 494±$48 323$116 859±$180 8330.34
    Intracranial bleed¶$84 652±$44 214$104 100±$15 626 0.04
    TBI$80 629±$94 358$510 434±$482 190 0.03
    Extremity fracture$118 547±$213 981$87 020±$113 8980.72
    Face fracture$121 666±$182 678$64 763±$30 2400.90
    • Results in text reported as difference between value in ‘With variable’ column as compared to ‘Without variable’ column. For example, male patients had an average total billing of $101 146 as compared to female patients with an average total billing of $83 932, amounting to an increased cost of $17 214 for male patients as compared to female patients.

    • *As reported by patient or clinical plan for follow-up visits.

    • †Intoxication defined as defined by clinical evaluation, positive BAL or urine toxicology.

    • ‡BAL >11 mmol/L.

    • §Patient brought in by ambulance (BIBA).

    • ¶Intracranial head bleeds including subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematoma, epidural hematoma and intraventricular hemorrhage.

    • BAL, blood alcohol level; ISS, Injury Severity Score; TBI, traumatic brain injury.

  • Table 5

    Multivariable regression of total billing cost

    Estimate95% CIP value
    Patient demographics
    Male−$79 578−$199 772–$40 6150.18
    Age (years)
     <40Ref.
     40–64−$5385−$89 424–$78 6550.90
     >64$39 818−$138 111–$217 7470.65
    Out-of-town visitor−$50 191−$306 275–$205 8930.69
    Injury context
    Motor vehicle involvement$17 812−$124 103–$159 7280.80
    Helmet use−$159 708−$413 329–$93 9130.21
    Any intoxication*$231 377$32 501–$430 254 0.02
    Clinical course
    BIBA†−$10 475−$111 059–$90 1100.83
    Number of consultations
     0–1Ref.
     >2$200 339$47 452–$353 226 0.01
    Injuries
    ISS
     <6Ref.
     6–9$2930−$168 469–$174 3290.97
     10–14$6862−$202 951–$216 6760.95
     >14$25 815−$258 010–$309 6400.85
    Primary Injury
     OrthopedicRef.
     Facial−$67 604−$239 177–$103 9690.42
     Cranial$57 648−$161 254–$276 5500.59
    Intracranial bleed‡$ 75 528$ 63 169 to $87 887 0.04
    TBI$360 898$116 228–$605 568 0.006
    Extremity fracture−$60 896−$225 661–$103 8700.45
    Face fracture$102 330−$103 647–$308 3080.31
    • *Intoxication defined as defined by clinical evaluation, positive BAL or urine toxicology.

    • †Patient brought in by ambulance (BIBA).

    • ‡Intracranial head bleeds including subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematoma, epidural hematoma and intraventricular hemorrhage.

    • ISS, Injury Severity Score; TBI, traumatic brain injury.

Supplementary Materials

  • Tables
  • Additional Files
  • Supplementary data

    [tsaco-2020-000634supp001.pdf]

Additional Files

  • Tables
  • Supplementary Materials
  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)
Ophelie Lavoie-Gagne, Matthew Siow, William E Harkin, Alec R Flores, Carey S Politzer, Brendon C Mitchell, Paul J Girard, Alexandra K Schwartz, William T Kent
Trauma Surg Acute Care Open Jan 2021, 6 (1) e000634; DOI: 10.1136/tsaco-2020-000634

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Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)
Ophelie Lavoie-Gagne, Matthew Siow, William E Harkin, Alec R Flores, Carey S Politzer, Brendon C Mitchell, Paul J Girard, Alexandra K Schwartz, William T Kent
Trauma Surg Acute Care Open Jan 2021, 6 (1) e000634; DOI: 10.1136/tsaco-2020-000634
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Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)
Ophelie Lavoie-Gagne, Matthew Siow, William E Harkin, Alec R Flores, Carey S Politzer, Brendon C Mitchell, Paul J Girard, Alexandra K Schwartz, William T Kent
Trauma Surgery & Acute Care Open Jan 2021, 6 (1) e000634; DOI: 10.1136/tsaco-2020-000634
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