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Trends in the Management of Pediatric Trigger Thumb in the United States
Keon Min Park1, Igor Immerman1, Paymon Rahgozar1
1University of California, San Francisco, USA.
Insights
Pediatric trigger thumb is often treated surgically at younger ages than recommended, potentially leading to overtreatment and increased healthcare costs. Current management trends may not align with evidence supporting conservative approaches for trigger thumb in children.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Health Services Research
Background:
- Literature suggests conservative management for pediatric trigger thumb can lead to spontaneous resolution.
- Current treatment trends for pediatric trigger thumb require analysis to compare with existing evidence.
Purpose of the Study:
- To analyze current management trends for pediatric trigger thumb.
- To compare real-world treatment data with literature recommendations.
Main Methods:
- Retrospective study using the PearlDiver database (2015-2018).
- Identified pediatric patients (<10 years) with trigger thumb using ICD codes.
- Analyzed surgical treatment, demographics, comorbidities, hand therapy, and costs using CPT codes.
Main Results:
- 49% of 997 pediatric patients underwent surgery for trigger thumb.
- Most surgeries (76%) occurred before age 5, often within one year of diagnosis.
- Surgical treatment averaged $1363/patient, compared to $593/patient for non-surgical management.
Conclusions:
- Pediatric trigger thumb is frequently managed surgically at younger ages than literature supports.
- Potential overtreatment of pediatric trigger thumb increases patient risk and healthcare expenditure.
- Management patterns for pediatric trigger thumb warrant re-evaluation to align with evidence-based practices.
Background:
Recent literature suggests that initial observation of pediatric trigger thumb without early surgical interventions can lead to spontaneous resolution. We sought to analyze current trends in the management of pediatric trigger thumb and compare real-world data with what the literature supports.
Methods:
We conducted a retrospective study of data collected using the PearlDiver database between 2015 and 2018. Patients who were aged younger than 10 years with a diagnosis of trigger thumb were identified using International Classification of Diseases codes. Current Procedural Terminology codes were used to identify patients who had an operation for trigger thumb. Patient demographics, comorbidities, utilization of hand therapy, and treatment cost were also collected.
Result:
Of the 997 patients included in the study, 69% were diagnosed with trigger thumb between the age of 2 and 5 years. In all, 492 patients (49%) had surgery for trigger thumb: 65% of patients had surgery within 1 year of diagnosis, and 76% patients had surgery before the age of 5 years. This treatment pattern was similar across multiple regions of the United States, and there were no significant predictors for surgery. The average cost of treating patients without surgery was $593/patient, whereas that for patients with surgery was $1363/patient.
Conclusions:
Nationwide data show that pediatric trigger thumb may be managed surgically at higher frequencies and in patients at younger ages than supported by the existing literature. Possible overtreatment is not only detrimental to patients but also burdens the health care system with unnecessary cost.
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