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Increasing rates of surgical treatment for paediatric diaphyseal forearm fractures: a National Database Study from
A I Cruz1, J E Kleiner2, S F DeFroda2
1Department of Orthopaedics, Division of Paediatric Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
Insights
Surgical treatment for pediatric forearm fractures increased from 2000 to 2012. Older age, male gender, and children
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Health Services Research
Background:
- Pediatric forearm fractures are common injuries.
- Non-operative management is frequent.
- Trends in surgical treatment rates are not well-established.
Purpose of the Study:
- To estimate the rate of inpatient surgical treatment for pediatric forearm fractures over time.
- To identify factors associated with surgical treatment.
Main Methods:
- Analysis of the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from 2000-2012.
- Identification of forearm fractures and surgeries using ICD-9-CM codes.
- Univariable and multivariable logistic regression to determine predictors of surgical treatment.
Main Results:
- A total of 30,936 pediatric forearm fracture admissions were identified.
- The overall surgical treatment rate increased from 59.3% in 2000 to 70.0% in 2012 (p < 0.001).
- Older age, male gender, children's hospital admission, and non-Medicaid insurance were associated with increased surgical rates.
Conclusions:
- The rate of operative treatment for pediatric forearm fractures has significantly increased.
- Factors influencing surgical treatment include patient demographics and insurance status.
- These findings highlight evolving treatment patterns in pediatric orthopedic trauma.
Forearm:
Purpose fractures are one of the most commonly sustained injuries in children and are often treated non-operatively. The purpose of this study was to estimate the rate of inpatient surgical treatment of paediatric forearm fractures over time using a large, publicly available, national database.
Methods:
The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was evaluated between 2000 and 2012. Forearm fractures and surgeries were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis and procedure codes. Univariable and multivariable logistic regression were used to determine variables associated with greater proportion of surgical treatment. All statistical analyses were performed using SAS statistical software v.9.4 (SAS Institute Inc., Cary, NC, USA). Statistical significance was set at p < 0.05.
Results:
The database identified 30 936 forearm fracture admissions. Overall, 19 837 of these patients were treated surgically (64.12%). The percentage of patients treated with surgery increased from 59.3% in 2000 to 70.0% in 2012 (p < 0.001). Multivariable regression analysis found increased age (p < 0.001), more recent year (p < 0.001), male gender (p = 0.003) and admission to a children's hospital (p < 0.001) were associated with an increased proportion of patients receiving surgical treatment. Medicaid payer status was associated with a lower proportion of surgical treatment (p < 0.001).
Conclusions:
The rate of operative treatment for paediatric forearm fractures admitted to the hospital increased over time. Increased surgical rates were associated with older age, male gender, treatment at a children's hospital and non-Medicaid insurance status.
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