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Presentation and Referral Patterns in Pediatric Closed Hand Fractures
Landis R Walsh1, Laura C Nuzzi1, Amir H Taghinia1
1Boston Children's Hospital and Harvard Medical School, MA, USA.
Hand (New York, N.Y.)
|April 26, 2021
Summary
Pediatric hand fractures often lead to inefficient referrals due to surgeon anxiety. Improving provider education and communication can enhance care efficiency and reduce costs for these common injuries.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Hand Surgery
Background:
- Pediatric hand fractures are common injuries.
- Non-hand surgeons experience anxiety managing these fractures due to unfamiliarity.
- This anxiety may contribute to inefficient patient referral patterns.
Purpose of the Study:
- To investigate referral patterns for pediatric hand fractures.
- To identify inefficiencies in the care pathway for these injuries.
- To explore the relationship between provider experience and referral pathways.
Main Methods:
- Retrospective review of pediatric patients with isolated, closed hand fractures.
- Data collected from January 2017 to December 2018.
- Analysis of patient demographics, treatment, and referral pathways.
Main Results:
- 454 pediatric patients were included; most were treated nonoperatively with few complications.
- Approximately half of cases initially presented to an outside provider.
- A significant percentage of patients saw multiple providers before a hand surgeon, particularly those aged 7-11.
- Surgery was required in 47 patients, but none were urgent.
Conclusions:
- Pediatric closed hand fractures typically have good nonoperative outcomes.
- Inefficient referral patterns, including multiple emergency department (ED) visits, are prevalent.
- Enhanced education for ED and primary care providers, along with improved communication with hand surgeons, is needed to optimize care and reduce costs.
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