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Factors That Drive Annual Variation in Pediatric Elbow Fracture Occurrence, Severity, and Resource Utilization
Jacob D Schultz1, Andrew B Rees1, Lucas C Wollenman1
1Vanderbilt University School of Medicine.
Insights
Increased daylight during school months drives pediatric elbow fractures, but summer breaks see fewer, more severe injuries. This impacts resource needs for emergency care and surgery.
Area of Science:
- Pediatric Orthopedics
- Epidemiology
- Health Services Research
Background:
- Pediatric elbow fractures are common, often requiring surgery.
- Annual factors influencing incidence, severity, and resource use are not well understood.
- This study investigates patterns in pediatric elbow fractures and their impact on healthcare resources.
Purpose of the Study:
- To document annual patterns of pediatric elbow fracture incidence and severity.
- To analyze the impact of these patterns on emergency department, emergency medical service (EMS), and operating room (OR) resource utilization.
- To identify factors driving pediatric elbow fracture incidence, severity, and resource demands.
Main Methods:
- Retrospective cohort study of 4414 pediatric elbow fractures (2007-2017).
- Data collected on presentation, injury patterns, transport, and treatment.
- Pearson correlations analyzed factors influencing fracture incidence, severity, and resource utilization.
Main Results:
- Fracture incidence positively correlated with monthly daylight hours, with fewer fractures during summer vacation.
- Despite fewer summer fractures, they were more severe, with higher displacement and neurovascular injury risk.
- Fractures required significant OR hours (7.7% of pediatric orthopaedic OR time), hospital admissions, and EMS transport.
Conclusions:
- Increased daylight during school sessions is a key factor in pediatric elbow fracture incidence.
- Higher severity fractures occur during summer, increasing the need for emergency transport and operative treatment.
- Findings provide data for optimizing resource allocation in pediatric orthopaedic care.
Background:
Elbow fractures are the most common pediatric fractures requiring operative treatment. To date, few studies have examined what annual factors drive pediatric elbow fracture incidence and no studies have examined which annual factors drive elbow fracture severity or resource utilization. The goal of this study was to not only document the annual patterns of pediatric elbow fracture incidence and severity but also the impact of these patterns on resource utilization in the emergency department, emergency medical service transportation, and the operating room (OR).
Methods:
Retrospective cohort study of 4414 pediatric elbow fractures from a single tertiary hospital (2007 to 2017). Exclusion criteria included outside treatment or lack of diagnosis by an orthopaedist. Presentation information, injury patterns, transport, and treatment requirements were collected. Pearson correlations were used to analyze factors influencing fracture incidence, severity, and resource utilization.
Results:
Pediatric elbow fracture incidence positively correlated with monthly daylight hours, but significantly fewer elbow fractures occurred during summer vacation from school compared with surrounding in school months. While fewer overall fractures occurred during summer break, the fractures sustained were greater in severity, conferring higher rates of displacement, higher risk of neurovascular injury, and greater needs for emergency transportation and operative treatment. Yearly, elbow fractures required 320.6 OR hours (7.7% of all pediatric orthopaedic OR time and 12.3% of all pediatric orthopaedic operative procedures), 203.4 hospital admissions, and a total of 4753.7 miles traveled by emergency medical service transportation to manage. All-cause emergency department visits were negatively correlated with daylight hours, inversing the pattern seen in elbow fractures.
Conclusion:
Increased daylight, while school was in session, was a major driver of the incidence of pediatric elbow fractures. While summer vacation conferred fewer fractures, these were of higher severity. As such, increased daylight correlated strongly with monthly resource utilization, including the need for emergency transportation and operative treatment. This study provides objective data by which providers and administrators can more accurately allocate resources.
Level Of Evidence:
Level III-Retrospective comparative study.
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