دورية أكاديمية
Characteristics and Hospital Costs of Spica Cast Treatment of Non-accidental-related Diaphyseal Femoral Fractures in Children Before Walking Age.
العنوان: | Characteristics and Hospital Costs of Spica Cast Treatment of Non-accidental-related Diaphyseal Femoral Fractures in Children Before Walking Age. |
---|---|
المؤلفون: | Magee LC; Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA., Mahmoud MAH, Baldwin K, Talwar D, Gandhi JS, Arkader A |
المصدر: | Journal of pediatric orthopedics [J Pediatr Orthop] 2020 Nov/Dec; Vol. 40 (10), pp. e932-e935. |
نوع المنشور: | Comparative Study; Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8109053 Publication Model: Print Cited Medium: Internet ISSN: 1539-2570 (Electronic) Linking ISSN: 02716798 NLM ISO Abbreviation: J Pediatr Orthop Subsets: MEDLINE |
أسماء مطبوعة: | Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins Original Publication: New York Ny : Raven Press |
مواضيع طبية MeSH: | Battered Child Syndrome/*economics , Battered Child Syndrome/*therapy , Femoral Fractures/*economics , Femoral Fractures/*therapy, Casts, Surgical/economics ; Child Abuse ; Female ; Femur ; Health Care Costs/statistics & numerical data ; Hospital Costs ; Hospitals ; Humans ; Infant ; Length of Stay/economics ; Length of Stay/statistics & numerical data ; Male ; Radiography/statistics & numerical data ; Retrospective Studies |
مستخلص: | Background: Fractures are one of the most common presentations of child abuse second only to soft tissue damage, with ∼60% of fractures being femur, humerus or tibia fractures. Although studies have shown increased health care costs associated with nonaccidental trauma (NAT), there is little data regarding the cost of NAT-associated fractures compared with accidental trauma (AT) related fractures. The purpose of this study was to consider the economic burden of NAT related femoral fractures compared with AT femoral fractures. Methods: We performed a retrospective study of children under the age of one with femoral fractures treated with a spica cast at a Level 1 Pediatric Trauma Center between 2007 and 2016. Variables included age, sex, length of hospital stay, and estimated total billing cost obtained from this hospital's billing department. In addition, fracture site (mid-shaft, distal, proximal, and subtrochanteric) and pattern were assessed. Results: Sixty children with a mean age of 7 months were analyzed. NAT was suspected in 19 cases (31.7%) and confirmed in 9 (15%) before discharge. Two groups were analyzed: the NAT group included suspected and confirmed cases of abuse (28) and the AT group contained the remaining 32 cases. There was no significant difference in the demographics between these 2 groups. Children in NAT group had a longer length of stay compared with AT group (78.9 vs. 36.7 h, P<0.001). Overall consumer price index-adjusted hospital costs were $24,726 higher for NAT group compared with AT group (P=0.024), with costs of laboratory workup, radiology, and nonorthopaedic physician fees being the top 3 components contributing to the increased costs. Conclusions: The overall incidence of NAT was 46.6% in children presenting with femoral fracture under 1 year of age. The overall hospital cost of treating fractures in the NAT group was 1.5 times higher than the AT group, with imaging charges the most significant contributor to cost difference. Level of Evidence: Level III-retrospective review. |
References: | Paul AR, Adamo MA. Non-accidental trauma in pediatric patients: a review of epidemiology, pathophysiology, diagnosis and treatment. Transl Pediatr. 2014;3:195–207. Bureau USC. Children characteristics: United States; 2016. Feldman KW, Bethel R, Shugerman RP, et al. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108:636–646. Deans KJ, Thackeray J, Askegard-Giesmann JR, et al. Mortality increases with recurrent episodes of nonaccidental trauma in children. J Trauma Acute Care Surg. 2013;75:161–165. Clarke NM, Shelton FR, Taylor CC, et al. The incidence of fractures in children under the age of 24 months—in relation to non-accidental injury. Injury. 2012;43:762–765. Schwend RM, Werth C, Johnston A. Femur shaft fractures in toddlers and young children: rarely from child abuse. J Pediatr Orthop. 2000;20:475–481. Wood JN, Mondestin V, Rubin DM, et al. Prevalence of abuse among young children with femur fractures: a systematic review. BMC Pediatr. 2014;14:169. Peterson C, Florence C, Klevens J. The economic burden of child maltreatment in the United States, 2015. Child Abuse Negl. 2018;86:178–183. Irazuzta JE, McJunkin JE, Danadian K, et al. Outcome and cost of child abuse. Child Abuse Negl. 1997;21:751–757. Thomas SA, Rosenfield NS, Leventhal JM, et al. Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics. 1991;88:471–476. Baldwin K, Pandya NK, Wolfgruber H, et al. Femur fractures in the pediatric population: abuse or accidental trauma? Clin Orthop Relat Res. 2011;469:798–804. Anda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006;256:174–186. Flaherty EG, Stirling J Jr. American Academy of Pediatrics. Committee on Child Abuse and Neglect. Clinical report-the pediatrician’s role in child maltreatment prevention. Pediatrics. 2010;126:833–841. Florence C, Brown DS, Fang X, et al. Health care costs associated with child maltreatment: impact on medicaid. Pediatrics. 2013;132:312–318. Brown DS, Fang X, Florence CS. Medical costs attributable to child maltreatment a systematic review of short- and long-term effects. Am J Prev Med. 2011;41:627–635. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg. 2004;12:347–359. Arkader A, Friedman JE, Warner WC Jr, et al. Complete distal femoral metaphyseal fractures: a harbinger of child abuse before walking age. J Pediatr Orthop. 2007;27:751–753. Loder RTFJ. Orthopaedic injuries in children with nonaccidental trauma: demographics and incidence from the 2000 kids’ inpatient database. J Pediatr Orthop. 2007;27:421–426. Gross RH, Stranger M. Causative factors responsible for femoral fractures in infants and young children. J Pediatr Orthop. 1983;3:341–343. U.S. Department of Health & Human Services AfCaF, Administration on Children, Youth and Families, Children’s Bureau. Child Maltreatment; 2017. Available at: www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment. Accessed December 12, 2019. Pierce MC, Bertocci GE, Vogeley E, et al. Evaluating long bone fractures in children: a biomechanical approach with illustrative cases. Child Abuse Negl. 2004;28:505–524. Murphy R, Kelly DM, Moisan A, et al. Transverse fractures of the femoral shaft are a better predictor of nonaccidental trauma in young children than spiral fractures are. J Bone Joint Surg Am. 2015;97:106–111. Rex C, Kay PR. Features of femoral fractures in nonaccidental injury. J Pediatr Orthop. 2000;20:411–413. Livingston JK, Grigorian A, Kuza CM, et al. Non-accidental trauma increases length of stay and mortality in pediatric trauma. Pediatr Surg Int. 2019;35:779–784. DiScala C, Sege R, Li G, et al. Child abuse and unintentional injuries: a 10-year retrospective. Arch Pediatr Adolesc Med. 2000;154:16–22. Lane WG, Lotwin I, Dubowitz H, et al. Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma. Pediatrics. 2011;127:e1400–e1405. Section on Radiology, American Academy of Pediatrics. Diagnostic imaging of child abuse. Pediatrics. 2009;123:1430–1435. Glenn K, Powell C, Kontos K. Radiological investigation in suspected child abuse (RISCA). Arch Dis Child. 2017;102:A198–A199. Jevsevar DS, Shea KG, Murray JN, et al. AAOS clinical practice guideline on the treatment of pediatric diaphyseal femur fractures. J Am Acad Orthop Surg. 2015;23:e101. Macmillan HL, Wathen CN, Barlow J, et al. Interventions to prevent child maltreatment and associated impairment. Lancet. 2009;373:250–266. Pelletier HL, Knox M. Incorporating child maltreatment training into medical school curricula. J Child Adolesc Trauma. 2017;10:267–274. Benedetti G. Innovations in the field of child abuse and neglect prevention: a review of the literature. Chicago, IL: Chapin Hall at the University of Chicago; 2012. Sink EL, Hyman JE, Matheny T, et al. Child abuse: the role of the orthopaedic surgeon in nonaccidental trauma. Clin Orthop Relat Res. 2011;469:790–797. Ranade SC, Allen AK, Deutsch SA. The role of the orthopaedic surgeon in the identification and management of nonaccidental trauma. J Am Acad Orthop Surg. 2020;28:53–65. |
تواريخ الأحداث: | Date Created: 20200803 Date Completed: 20210211 Latest Revision: 20210211 |
رمز التحديث: | 20231215 |
DOI: | 10.1097/BPO.0000000000001577 |
PMID: | 32740177 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1539-2570 |
---|---|
DOI: | 10.1097/BPO.0000000000001577 |