Fractures Among Inpatients in a Pediatric Hospital

Area of Science:

• Pediatric Bone Health
• Hospital-Acquired Conditions
• Patient Safety

Background:

• Inpatient pediatric fractures are an underrecognized source of harm.
• Limited data exist on the clinical profiles of children experiencing fractures during hospitalization.
• Fractures can impact both current and future bone health in children.

Purpose of the Study:

• To describe the clinical characteristics of pediatric patients who sustained fractures while hospitalized.
• To analyze the incidence and common sites of inpatient pediatric fractures.
• To evaluate the effectiveness of different methods for identifying inpatient fractures.

Main Methods:

• Retrospective identification of inpatient fractures using a voluntary safety event reporting system and electronic medical record keyword searches.
• Collection of clinical characteristics, laboratory data, and survival status from medical records.
• Analysis of fracture locations and patient demographics.

Main Results:

• Fifty-six subjects experienced 128 fractures, most commonly femur and humerus fractures.
• High-risk patient characteristics included age ≤1 year (64%), preterm birth (53%), ICU admission (90%), and immobilization (88%).
• A voluntary reporting system identified only 57% of fractures, highlighting detection limitations.

Conclusions:

• Critically ill, immobilized infants under one year, often born preterm, represent the majority of hospitalized patients with fractures.
• Voluntary reporting systems are insufficient for comprehensive identification of inpatient pediatric fractures.
• Further research is needed on fracture screening strategies and the link between fracture severity, illness, and mortality in hospitalized children.