The burden of noncompliance with seat belt use on a trauma center.
BACKGROUND
It is well-known that noncompliance with seat belt use results in worse injury. The impact of noncompliance on hospital resource consumption and hospital charges is less well known. This study was carried out to examine the economic burden of noncompliance with seat belt use.


METHODS
Trauma registry data were reviewed for patients involved in motor vehicle crashes in 2003 and 2004. Routine demographic data were analyzed. Outcome data included hospital length of stay, intensive care unit length of stay, number of ventilator days, and mortality. Hospital charges, rate of collection, hospital use (measured by need for admission), operating room use, and intensive care unit use were calculated to determine the burden of noncompliance with seat belt use.


RESULTS
There were 3,426 patients identified for analysis. Of these patients, 1,744 (51%) were compliant with seat belt use (SEAT) while 1,682 were not compliant (NO SEAT). Patients in the NO SEAT group were significantly younger (31.2 versus 37.4 years old) and significantly more severely injured (Injury Severity Score of 11 versus 7) than those in the SEAT group. Patients in the NO SEAT group had a significantly longer hospital length of stay (4.4 versus 2.2 days) and intensive care unit length of stay (1.4 versus 0.3 days), as well as significantly more ventilator days (1.2 versus 0.2 days) than those in the SEAT group. Mortality was more than doubled in the NO SEAT group (2.2 versus 0.9%) as compared with the SEAT group. Resource consumption was significantly greater in the NO SEAT group, as evidenced by increased hospital use (64.9 versus 39%), increased critical care unit use (22.9 versus 10.3%) and increased operating room use (9.2 versus 4.9%) when compared with the SEAT group. Subsequently, hospital charges were significantly higher in the NO SEAT group ($32,138 versus $16,547) than in the SEAT group. Charge collection rate was lower in the NO SEAT group (30.5 versus 42.5%) than in the SEAT group.


CONCLUSIONS
These data quantify the burden placed on a trauma center by noncompliance with seat belt use. This information should drive more focused education and injury prevention programs. It should also be clearly articulated to legislators to stimulate more support for more stringent legislative policy and improved trauma center funding.
The University of Florida Health Science Center-Jacksonville, Department of Surgery, Division of Trauma/Critical Care, Jacksonville, Florida 32209, USA. andy.kerwin@jax.ufl.edu
Andrew J
AJ
Kerwin
Margaret M
MM
Griffen
Joseph J
JJ
Tepas
Miren A
MA
Schinco
Pam
P
Pieper
Terri
T
Devin
Eric R
ER
Frykberg
D000063:Accidents, Traffic / Q000191:economics / Q000401:mortality*; D000328:Adult; D002423:Cause of Death; D017281:Cost of Illness; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005382:Financing, Personal / Q000191:economics; D005431:Florida; D017052:Hospital Mortality; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D012042:Registries / Q000706:statistics & numerical data; D012622:Seat Belts / Q000191:economics / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality / Q000601:surgery*