Wednesday, August 31, 2011

Sprained Ankles Raising the Cost of ER Visits!

There is nothing cheap about healthcare and going to the ER can cost you an astonishing amount of money! In 2008 the average Emergency room bill was $1,265. What can you do when it is an emergency? How do you tell when you actually need to go to the emergency room and what can wait for an appointment?

A recent study published in Clinical Orthapaedics and Related Research took a closer look at lower extremity emergency room visits. They analyzed a total of 119,815 patient visits in 2009 and the most common injury was not an emergency! According to the study the most common diagnosis in the ER for the lower extremity is strains and sprains. This accounted for 36% percent of these visits. An ankle sprain was the most common injury with an incidence of 206 per 100,000 visits. But how do you know the difference between a sprain and a fracture?

Ankle sprains can be very painful and lead many to question: “Did I break something?” Ankle sprains are most common in young individuals with teenagers having the highest ER visits with such injuries than any other age group. Parents are often the ones making the critical decision if the injury warrants the visit to the ER. And If moms are still like my wonderful mom, they are better safe than sorry. The incidence of an ankle fracture is 49 per 100,000, much less than an ankle sprain. The symptoms are extremely similar consisting of pain and swelling and often an audible pop will be heard. Some like to use weight bearing as a guideline but I have seen both ankle fractures walk through the door and I’ve also seen ankle sprains unable to bear weight.

A team of doctors took up the challenge of differentiating between fractures and sprains in Ottawa, Canada and devised the Ottawa Radiograph Rules. They found that only 15% of foot and ankle x-rays in the ER revealed fractures. After implantation of their guidelines, they reduced the number of x-rays by 35%. These rules help determine when x-rays are necessary because of a highly suspected fracture, and when x-rays were unnecessary due to certainty of a simple sprain injury. In simplest terms the guidelines include bone tenderness and inability to bear weight.

The lesson here is that you don’t need to go to the ER to be diagnosed with a sprain or even an ankle fracture. Many specialties have time built into their schedule for emergency visits and many practices even have weekend hours. Depending on your insurance, you may not need a referral to see a foot and ankle specialist and you will cut your cost significantly by avoiding the costly ER. Nearly all podiatric practices have immediate access to x-ray in the office to make the appropriate diagnosis. Injuries can be painful and scary and it is always better to be safe than sorry but you don’t have to go the ER and get charged an arm and leg.

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