Medical charges for car crash victims with and without seat belts: implications for tribal health programs.

This study examines the charges for medical care for American Indian patients injured in motor vehicle crashes at one Indian Health Service hospital in northeastern Oklahoma. Specific focus is placed on the use of seat belts by motor vehicle crash victims. Medical charts were abstracted for all car occupant crash victims who were treated in the emergency room at the W.W. Hastings Hospital in Tahlequah, OK, from January 1 through September 30, 1994. Information was obtained on the restraint status of the patient, whether the person was admitted, length of hospital stay if admitted, position in the vehicle, age, sex, method of payment, and details concerning circumstances of injury. Only data concerning initial treatments were recorded: follow-up visits and deaths were not included. Also not included were victims injured as pedestrians, motorcyclists, bicyclists, occupants of truck beds, or riders in recreational vehicles. Data were analyzed using Epi-Info Version 6. A total of 62 patients were treated for motor vehicle-related injuries in this nine-month period. Of the 262 victims, restraint status at the time of injury was recorded for 216 (82%). Among these 216 victims with known restraint status, 80 (37%) were restrained at the time of their crash and 136 (63%) were not restrained. Of the 80 patients who were restrained, two (3%) were admitted to the hospital: one patient for 2 days, and the other for 10 days. This resulted in a calculated average length of stay (ALOS) of 6 days for the two restrained patients who were hospitalized. All other restrained victims were treated and released from the emergency room. Of the 136 victims who had not been wearing seat belts, 19 (14%) were hospitalized. The length of stay was reported for 15 of these patients and ranged from 1 to 64 days. For the unrestrained victims, the ALOS was 18.3 days. For the nine-month period of the study, the total estimated charges (inpatient and emergency services) calculated for restrained patients was $37,600, compared to $325,760 for unrestrained patients. Increasing the rates of seat belt and child restraint usage has the potential for dramatically reducing the serious injuries and resultant medical costs. This can be facilitated through enhanced car seat loaner programs; educational interventions in schools, worksites, and through the media; and passage and rigorous enforcement of primary restraint laws.