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Delays in Pediatric Supracondylar Humerus Fracture Management: A Comparison of Pre- and Postpandemic Trends
Annika Y Myers1, Michael J Colello, Tishya A L Wren
1From the Jackie and Gene Autry Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
Pediatric supracondylar humerus fracture care is delayed post-COVID-19. This study found longer times to admission, surgery, and hospital stays for children after the pandemic, impacting patient care.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Health Services Research
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- Understanding its effect on pediatric orthopedic care is crucial for optimizing patient outcomes.
- Pediatric supracondylar humerus fractures are common injuries requiring timely management.
Purpose of the Study:
- To compare patient presentation and management timeliness for pediatric supracondylar humerus fractures before and after the COVID-19 pandemic.
- To identify potential changes in emergency department (ED) flow and operating room availability.
- To assess the impact of the pandemic on pediatric fracture care pathways.
Main Methods:
- Retrospective review of pediatric patients with isolated supracondylar humerus fractures.
- Comparison of two groups: prepandemic (Jan 2018-Jun 2019) and postpandemic (Mar 2022-Aug 2023).
- Analysis included time to admission, surgical intervention, and length of stay.
Main Results:
- Postpandemic group showed significantly longer times to admission (4.0 vs 5.7 hours), surgery (9.2 vs 14.0 hours), and hospital stay (20.0 vs 22.9 hours) for ED-admitted patients.
- Transferred patients also experienced longer surgical intervention times (5.8 vs 7.4 hours) and hospital stays (17.1 vs 20.0 hours) postpandemic.
- Patients not requiring surgery in the postpandemic group had a longer length of stay (3.9 vs 5.0 hours).
Conclusions:
- Significant delays in the management of pediatric supracondylar humerus fractures have occurred since the COVID-19 pandemic.
- These delays necessitate a restructuring of hospital resources to improve patient experience and operational efficiency.
- Addressing these delays can enhance patient care, physician morale, and reduce hospital costs.
Background:
The purpose of this study is to compare patient presentation characteristics and timeliness of pediatric supracondylar humerus fracture management from before and after the COVID-19 pandemic. These comparisons may lead to the identification of changes in emergency department (ED) flow or operating room availability since the pandemic.
Methods:
A retrospective review was done of patients seen for an isolated supracondylar humerus fracture at a single tertiary care pediatric hospital. The prepandemic group presented from January 1, 2018 to June 30, 2019, and the postpandemic group presented from March 1, 2022 to August 31, 2023. The two groups were directly compared.
Results:
Three hundred eighty-eight patients were included in the prepandemic group, and 413 patients in the postpandemic group with a median age of 5.3 years. Of the patients who presented directly to our ED and were admitted, there was markedly longer time to admission (5.7 vs. 4.0 hours; P < 0.0001), time to surgical intervention (14.0 vs. 9.2 hours; P < 0.0001), and total length of stay (22.9 vs. 20.0 hours; P = 0.0004) in the postpandemic group. Similarly, of the patients who were transferred to our institution and were admitted, there was markedly longer time to surgical intervention (7.4 vs. 5.8 hours; P = 0.0029) and total length of stay (20.0 vs. 17.1 hours; P = 0.0002) in the postpandemic group. In the postpandemic group, patients who presented directly to our ED and did not require surgery had a markedly longer total length of stay (5.0 vs. 3.9 hours; P < 0.0001). Patients transferred to our ED in the postpandemic group were more likely to require nonsurgical care, although this did not reach significance (12% vs. 6%; P = 0.084).
Conclusion:
Since the pandemic, there have been notable delays in care for pediatric supracondylar humerus fractures. Identification of these delays provides support for the restructuring of hospital resources to help improve the patient experience and physician morale and decrease hospital costs.
Level Of Evidence:
III.
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