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Re-triage of severely injured patients in no-fault vs. at-fault states
Michael R Visenio1, Neil Thivalapill1, Casey M Silver2
1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Importance:
State no-fault laws enforce fewer administrative requirements for automotive insurance to pay hospitals for injury care costs than states without no-fault laws (at-fault states).
Objective:
Determine if no-fault states had lower re-triage (urgent inter-hospital transfer) of patients injured in motor-vehicle collision (MVC) than at-fault states.
Design:
This was an observational retrospective cohort study.
Setting:
FL, NY, MD and WI Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases from 2016 to 2021.
Participants:
Severely injured [injury severity score (RISS) > 15] Medicare patients.
Exposure:
FL and NY had no-fault laws, while MD and WI were at-fault states.
Main Outcome:
Re-triage was defined as same-day inter-hospital transfer to a high-level trauma center. Mixed effects multivariable logistic regression estimated the association between no-fault states and re-triage controlling for age, sex, race, comorbidity, RISS, diagnosis, trauma designation, hospital for-profit, adjusting for clustering within hospitals and states. A moderation analysis with an interaction term for mechanism * fault laws was conducted to estimate whether no-fault laws moderated adjusted odds of re-triage differently among patients severely injured in MVC versus falls.
Results:
In total 6447 Medicare patients in 345 hospitals were severely injured in MVCs among four states. Median age was 70 years [interquartile range (IQR):65-78]. Neurological injury was the most common diagnosis (38.8%). Unadjusted re-triage rates were 2.3% in no-fault and 8.1% in at-fault states (p < 0.001). No-fault states had 0.31 lower adjusted odds of re-triage (95% Confidence Interval:0.17-0.56) of severely patients injured in MVCs compared to at-fault states. A moderation analysis with an interaction term for mechanism * fault laws demonstrated Medicare MVC injured patients in at-fault states had 1.77 higher adjusted odds of re-triage compared to falls in at-fault states (95% Confidence Interval=1.23-2.54). Medicare patients severely injured in MVC in no-fault states had 0.38 adjusted odds of re-triage compared to fall patients in at-fault states, 95% Confidence Interval 0.22-0.66.
Conclusion And Relevance:
Automotive insurance laws moderate odds of re-triage among severely injured MVC patients but not fall patients.
Level Of Evidence:
Level III.
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