Graduation Year


Document Type




Degree Name

Doctor of Public Health (Dr.PH.)

Degree Granting Department

Health Policy and Management

Major Professor

Barbara Langland-Orban, Ph.D.

Committee Member

Karen Liller, Ph.D.

Committee Member

Etienne Pracht, Ph.D.

Committee Member

Troy Quast, Ph.D.

Committee Member

Roneé Wilson, Ph.D.


youth, injury, healthcare costs, sports, policy, trauma



The goal of this dissertation was to identify evidence regarding potential means to reduce healthcare spending on youth injury while protecting and promoting the health of our youth. The first analysis estimated and analyzed both the financial costs and time lost from sports injuries among inpatient and ED youth patients to aid in identifying key populations, raising awareness to policy makers, and emphasizing the need of prevention programs for sports injury. The second analysis analyzed the effect of volume and trauma center (TC) ownership type on trauma alert response charges, which are billed to injured patients for a trauma team activation. The objectives of the third analysis were to evaluate associations of mechanism of injury in youth who have been misclassified as trauma alerts, and to analyze the effect of misclassified youth on healthcare costs.


The first study was a retrospective analysis of sports injuries identified in Florida’s Agency for Healthcare Administration (AHCA) 2010-2014 all-inclusive inpatient and ED datasets. The study population included all hospital patients, aged 5 to 18 years, with a recorded injury from sport. Fixed effects linear and negative binomial regression were used. In the second analysis, every inpatient who visited a TC in Florida and was billed a trauma response charge from 2012 to 2014 was included for a total of 45,993 observations. Multiple linear regression, controlling for patient and hospital factors, was used to find associations between volume and trauma response charges and hospital ownership type and charges. Severity elasticity of trauma response charges was calculated by ownership type. AHCA's 2012-2014 inpatient and financial data were used in the third analysis. The study population included patients, aged 5 to 18 years with no surgery, an ICISS score ≥ .90, a hospital stay less than 24 hours, discharged to home, with recorded mechanism and defined injury. Misclassified patients were those designated as a trauma alert in the field. Logistic and multivariable linear regression were used.


Over the five year period, sports injuries in Florida youth cost $24,555,547 for inpatient care and $87,083,482 for ED care. Youth spent 10,397 days in the hospital and a total of 536,893 hours in the ED. Youth averaged $6,039 and 2.5 days for an inpatient visit and $439 and 2.3 hours for an ED visit in costs from sports injuries. Volume had a significant, inverse relationship with trauma response charges. For-profit TCs had statistically higher trauma response charges and government owned TCs had statistically lower trauma response charges than not-for-profits. For-profit TCs had an inelastic response to severity for trauma response charges. The mechanisms of injury of firearm, motor vehicle traffic, and transport were significantly, positively associated with misclassification as a trauma alert. Inpatient costs were associated with an 87% increase for patients who were misclassified as a trauma alert.


Older athletes and males consistently have high healthcare costs from sports. Baseball, basketball, bike riding, football, rollerskating/skateboarding, and soccer are sports with high costs for both ED patients and inpatients and would benefit from prevention programs. Injuries from noncontact sport participants are few but can have high costs. These athletes could benefit from prevention programs as well. Trauma response charges are higher when patient volume is reduced and at for-profit TCs. If injured youth had visited government or not-for-profit TCs, an estimated annual $6.5 to $8.3 million reduction in trauma response charges would have occurred. Reducing these charges are a potential way to reduce excessive healthcare spending without decreasing quality. Mechanism of injury is not a reliable predictor of trauma and was associated with misclassification of pediatric patients with minor injuries as trauma alerts. Costs were higher for mildly injured patients who were trauma alerted, in part due to the trauma alert charge.

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