MOTOR VEHICLE-RELATED INJURY PREVENTION (Counseling)

Evidence Statement Benefit Plan Language Other Information and Resources Author(s)

References


Updated 6/6/11

Evidence Statement

Clinical Preventive Service Recommendations

U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force (USPSTF) issued a recommendation on counseling to prevent motor vehicle crash injuries in 1996. Given the availability of new evidence, the USPSTF decided to update its 1996 recommendation. This work is currently in progress. Please refer to the USPSTF website for updates (www.ahrq.gov/clinic/prevenix.htm).

American Academy of Family Physicians (AAFP)
The American Academy of Family Physicians (AAFP) recommends that physicians counsel all parents and patients over the age of 2 years regarding accidental injury prevention including, as appropriate: child safety seats, lap and shoulder belt use, bicycle safety, motorcycle helmet use, and driving while intoxicated.1

Evidence Rating: R (Recommended)
Although evidence exists which demonstrates net benefit, either the benefit is only moderate in magnitude or the evidence supporting a substantial benefit is only fair. The intervention is perceived to be cost effective and acceptable to most patients. The AAFP Summary of Recommendations for Clinical Preventive Services (RCPS) originated in the Commission on Clinical Policies and Research and was approved by the AAFP Board of Directors in August 2005.

The starting point for the recommendations is the rigorous analysis of scientific knowledge available as presented by the U.S. Preventive Services Task Force (USPSTF) in their Guide to Clinical Preventive Services, 2nd Edition and ongoing releases of evidence reports and recommendations from the 3rd Edition.

The AMA urges physicians to educate their patients about the dangers of alcohol abuse and operating a motor vehicle while under the influence of alcohol.2



Condition / Disease Specific Information

Epidemiology of Injury
Motor vehicle-related injuries kill more children and young adults (18 to 34 years of age) than any other single cause in the United States.1 In a given year, 41,000 Americans will die in motor vehicle crashes, 500,000 will have crash injuries requiring hospitalization, and 4 million will have crash injuries requiring a visit to an emergency department.5

In the United States during 2004, 1,638 children ages 14 years and younger died as occupants in motor vehicle-related crashes, and approximately 214,000 were injured resulting in an average of 6 deaths and 673 injuries each day.6

During 2004, 16,694 people in the United States died in alcohol-related motor vehicle crashes, representing 39% of all traffic-related deaths.6 Drugs other than alcohol (e.g., marijuana and cocaine) are involved in about 18% of motor vehicle deaths. These drugs are usually used in combination with alcohol.7 Nearly three quarters of those convicted of driving while impaired are either frequent heavy drinkers (alcohol abusers) or alcoholics (alcohol dependent).7

Injury Risk Factors
Risk factors for motor vehicle-related injuries among children include failing to use occupant protection, improper use of occupant protection, and being a passenger in a vehicle driven by a person under the influence of alcohol or other drugs. Restraint use among young children often depends upon the driver's restraint use. Almost 40% of children riding with unbelted drivers were themselves unrestrained.8 Even children who do use child restraints are at risk if they are improperly secured. A survey of more than 17,500 children found that only 15% of children in safety seats were correctly harnessed into correctly installed seats.8



The Value of Prevention

Economic Burden of Injury
The economic burden of motor vehicle-related deaths and injuries is enormous, costing the United States more than $230 billion each year (year 2000 dollars).9 Of the estimated $230 billion, $61 billion is due to lost workplace productivity, $59 billion due to property damages, $34 billion due to medical expenses, $25 billion due to delayed transit, $20 billion due to lost household productivity, $15 billion due to insurance administration, $11 billion due to legal fees, and $5 billion due to workplace administration.9

Costs due to motor vehicle injuries in children are estimated to approach $20 billion annually. Costs per child injured (when a child occupies a vehicle involved in a crash) are estimated at $10,600 per injury (updated to year 2000 dollars).10

Alcohol-involved crashes pose a great economic burden in the United States. The economic costs for motor vehicle injuries involving alcohol are estimated at $50.9 billion annually (year 2000 dollars).9

Workplace Burden of Injury
As stated above, the workplace burden of motor vehicle-related crashes is substantial. Each year, motor vehicle-related crashes result in $61 billion in lost productivity and $5 billion in workplace administrative costs (year 2000 dollars).9

Economic Benefit of Preventive Intervention
The savings associated with preventable medical-care costs, lost productivity, and other injury-related expenditures constitute the major economic benefit of counseling to prevent motor vehicle-related injuries. Including intangible consequences such as pain and suffering, the total value of preventing a motor vehicle-related death was estimated to be $3.4 million (in year 2000 dollars) per life saved.11

Estimated Cost of Preventive Intervention
In 2004, the private-sector cost of injury prevention counseling averaged $38 per session; approximately 95% of paid claims fell within the range of $0 to $129 per session.11

Estimated Cost of Treatment
The cost of motor-vehicle injuries varies tremendously depending on the type and severity of the injury.

Cost-Effectiveness and/or Cost-Benefit Analysis of Preventive Intervention
Injury prevention counseling by pediatricians has been shown to be cost-saving in some studies. The studied intervention included 11 brief sessions of approximately 1.5 minutes each, one of which was related to the use of child safety seats. Cost savings from the child safety seat counseling session ranged from $24 to $69 per child counseled. These counseling costs are comparable with the costs of counseling for other prevention messages.12-14

Counseling trauma patients (an injured patient treated in an emergency department or admitted to a hospital) on the dangers of alcohol was estimated to have a net cost-savings of $330 per patient intervention due to reduced future alcohol related trauma. The counseling included a brief screening and intervention session by a healthcare professional.15



Preventive Intervention Information

Preventive Intervention: Purpose of Counseling
Motor vehicle-related fatal and nonfatal injuries are highly preventable. Seatbelts, child safety seats, safety helmets (for motorcycles), and not driving while impaired by alcohol or drugs, are proven to reduce the risk of motor vehicle-related injuries.6,16-21 The rates of fatal and non-fatal motor vehicle-related injuries have declined in recent years, partially due to program and policy interventions designed to prevent these injuries.6,16-21 For example, over 80% of all adults use seat belts. However, children remain at high risk for motor-vehicle related injuries because only 15% of children are correctly harnessed into correctly installed safety seats.8

Benefits and Risks of Intervention
Several studies have evaluated counseling parents to increase seat belt usage among their children22-27 and to use safety seats for infants and newborns.26,28-37 Other studies have shown that counseling adolescents and adults can increase seat belt usage.24,27,38-40 In general, most of the evidence suggests that there is a relatively short-term effect of clinician counseling on the use of occupant restraints, indicating the need for periodic reinforcement of this message.

While little is known about how effectively clinicians can influence patients to refrain from driving while impaired by alcohol or other drugs, there is good evidence that brief clinician counseling can reduce alcohol consumption in problem drinkers, which may, in turn, result in reduced drinking and driving.43 Studies also find that counseling provided as a component of trauma care (care delivered to an injured patient in an emergency department of through hospitalization) significantly reduces injuries and the rate of trauma recidivism (re-injury).15,44,45 Further, despite the fact that there are over 159 million episodes of alcohol-impaired driving each year, only 1.5 million persons are arrested annually for driving under the influence of alcohol.46 Thus, it is likely that many patients would benefit from clinician counseling to modify their behaviors as drivers and passengers in motor vehicles. Since motor vehicle crashes represent a leading cause of death and nonfatal injury in the United States, even modest successes through clinical interventions could have major public health benefits.

Initiation, Cessation, and Interval of Counseling
Although the harms associated with counseling are not well-studied, they may include stigma, psychological stress, and anxiety. It is likely that these risks are minimal, and the harms associated with counseling are far outweighed by the benefits.

There is insufficient evidence to determine the optimal ages at which to begin and cease counseling to prevent motor vehicle-related injuries. Experts agree that counseling for motor vehicle-related injuries should be initiated and stopped when deemed appropriate by the clinician.

Likely initiation periods might be: 1) when patients first begin to drive (age 15, 16 or older depending on state law), 2) when patients first become parents, 3) when patients seek other preventive services for young children, 4) when patients present with alcohol or other drug dependencies, and 5) when patients receive trauma care for alcohol-related injuries.

Evidence is insufficient to determine the optimal interval to counsel patients about motor vehicle-related injuries. Thus, clinicians are encouraged to use their judgment in deciding how frequently to counsel patients for motor vehicle-related injuries. Clinicians should be encouraged to periodically reinforce prevention messages with all patients (at least once per year), particularly with those patients at high-risk of motor vehicle-related injuries (patients aged 18 to 33 years, parents of small children or adolescents, and substance and alcohol abusers).

Intervention Process
The specific method of counseling is left to the discretion of the clinician. Common methods of counseling include brief clinician counseling (3 minutes or less) and intensive counseling.

The provider of any patient who has suffered an alcohol-related motor vehicle crash should screen the individual for alcohol misuse. For more information on alcohol misuse screening and counseling please refer to the Alcohol Misuse Screening and Counseling Evidence-Statement.

Treatment Information
Not Applicable



Strength of Evidence

Evidence-Based Research:
American Academy of Family Physicians (AAFP)
Strength of Evidence: R (Recommended)
The AAFP recommends that physicians counsel all parents and patients over the age of 2 years regarding accidental injury prevention including, as appropriate: child safety seats, lap and shoulder belt use, and driving while intoxicated.1



Summary Plan Description

Covered Counseling
Counseling to reduce motor vehicle related injuries is a covered benefit. Both brief clinician counseling (3 minutes or less) and intensive counseling are covered.

Initiation, Cessation, and Interval
Counseling to prevent motor vehicle-related injuries is a covered benefit for beneficiaries of driving age. Counseling should be conducted: 1) when beneficiaries first begin to drive (age 15, 16, or older depending on state law), 2) when beneficiaries first become parents, 3) when beneficiaries seek other preventive services for young children, 4) when beneficiaries present with alcohol or other drug dependencies, and 5) when beneficiaries receive trauma care for alcohol-related injuries.

One counseling session is covered per year. Individuals at high risk for a motor vehicle-related injury (beneficiaries aged 18 to 33 years, parents of small children or adolescents, and substance and alcohol abusers) may be counseled more frequently, if medically indicated.



CPT Codes

Motor Vehicle-Related Injury Prevention (Counseling)
99401 Preventive medicine counseling/risk factor reduction, 15 minutes
99402 Preventive medicine counseling/risk factor reduction, 30 minutes
99403 Preventive medicine counseling/risk factor reduction, 45 minutes
99404 Preventive medicine counseling/risk factor reduction, 60 minutes




Other Information and Resources

Injury Cost Calculator

The Injury Cost Calculator allows employers to approximate the average costs of unintentional burns, falls, transportation-related injuries and poisonings among their employees. Results represent the average amount of money an employer could save by preventing these injuries.

Business Group Resource(s)

CDC Resource



Author(s)

Corso P. Motor vehicle-related injury prevention evidence-statement: counseling. In: Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.



References

1 American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations, revision 5.1, April 2006. Available at: http://www.aafp.org/exam.xml. Accessed May 26, 2009.
2 American Medical Association. Policy H-30.945, Drivers impaired by alcohol. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/388/underage_drnkndrive.pdf. Accessed May 27, 2009.
3 American Medical Association. Guidelines for Adolescent Preventive Services (GAPS) recommendations. Chicago, IL: American Medical Association; 1997. Available at: http://www.ama-assn.org/ama/upload/mm/39/gapsmono.pdf. Accessed May 27, 2009.
4 American Academy of Pediatrics Committee on Injury and Poison Prevention. Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents. Pediatrics. 2002 Mar; 109(3):550-3.
5 Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) 2005. Available at: http://www.cdc.gov/injury/wisqars/index.html Accessed May 27, 2009.
6 Department of Transportation. National Highway Traffic Safety Administration (NHTSA). Traffic safety facts 2004. Washington, DC: NHTSA; 2005.
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8 National Center for Injury Prevention and Control (NCIPC). Child passenger safety: fact sheet. Atlanta, GA: Centers for Disease Control and Prevention; 2005. Available at: http://www.cdc.gov/ncipc/factsheets/childpas.htm. Accessed May 27, 2009.
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