SURVIVORS OF MOTOR-VEHICLE TRAUMA - AN ANALYSIS OF SEAT-BELT USE AND HEALTH-CARE UTILIZATION

Objective: To determine whether the protective effects of seat belt us e on acute injury are followed by corresponding reductions in outpatie nt health care utilization. Design: Retrospective cohort analysis. Set ting: Northern California Region Kaiser Health Plan hospitals and medi cal offices. Patients: All Kaiser Foundation Health Plan members injur ed in motor vehicle crashes in Santa Clara County during one year (tot al number of patients = 246).Measurements and main results: 54% of the study participants had been wearing seat belts at the time of injury, and 46% had not been. The belted patients had fewer head injuries (30 % vs 50%, p < 0.05), better mean Injury Severity Scale scores (4.3 vs 7.4, p < 0.05), and smaller mean hospital charges ($8,580 vs $16,209, p < 0.05). However, the effects of injury did not end upon discharge f rom the trauma center; the patients averaged about eight outpatient vi sits during the subsequent year, a rate almost double their prior use. In contrast to inpatient measures of utilization, the patients who ha d been wearing seat belts at the time of injury had more outpatient vi sits during the year after injury than had their unbelted counterparts (9.0 vs 7.1, p < 0.05). This discrepancy was not explained by differe nces in amounts of utilization during the year before injury, which we re similar in the two groups (4.4 vs 4.8, p = NS). Overall, general in ternists provided the most follow-up care and accounted for the larges t discrepancy in utilization between the belted and unbelted patients. Conclusions: Seat belt use does not result in lower utilization of fo llow-up outpatient services in the year following injury. However, the beneficial effects on acute care utilization more than offset the mar ginal effects on subsequent medical services utilization.