Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Research Institute at the Hospital for Sick Children and Dalla Lana School of Public Health at the University of Toronto, Toronto, Ontario, Canada.
Ann Emerg Med. 2021 Feb;77(2):163-173. doi: 10.1016/j.annemergmed.2020.07.039. Epub 2020 Oct 21.
In patients with a distal radius buckle fracture, we determine whether home removal of a splint and physician follow-up as needed (home management) is noninferior to primary care physician follow-up in 1 to 2 weeks with respect to functional recovery. We also compare groups with respect to health care and patient-level costs.
This was a noninferiority randomized controlled trial conducted at a tertiary care children's hospital. Eligible patients were randomized to home management versus primary care physician follow-up and received telephone contact at 3 and 6 weeks after the index ED visit. Functional recovery was measured with the Activities Scale for Kids-performance, and participants reported wrist-injury-related health care interventions and expenses. The primary outcome was a comparison of the performance score between groups at 3 weeks.
We enrolled 149 patients with mean age 9.5 years (SD 2.7 years), and 81 (54.4%) were male patients. Of the 133 patients (89.3%) with completed 3-week follow-up, the mean Activities Scale for Kids-performance score was 95.4% in the home management group (n=66) and 95.9% in the primary care physician follow-up group (n=67) (mean difference -0.4%; lower bound of the 95% confidence interval -2.4%). There was a mean costs savings of -$100.10 (95% confidence interval -$130.0 to -$70.20) in health care and -$28.2 (95% confidence interval -$49.6 to -$7.0) in patient costs in the home management versus primary care physician follow-up group.
In patients with distal radius buckle fractures, home management is at least as good as primary care physician follow-up with respect to functional recovery. Implementation of the home management strategy also demonstrated significant cost savings.
在桡骨远端扣带骨折患者中，我们确定在功能恢复方面，与在 1 至 2 周内由初级保健医生进行随访相比，在家中去除夹板并根据需要进行医生随访（家庭管理）是否不劣于前者。我们还比较了两组的医疗保健和患者层面的成本。
这是一项在三级儿童保健医院进行的非劣效性随机对照试验。符合条件的患者被随机分配到家庭管理组或初级保健医生随访组，并在 ED 就诊后 3 周和 6 周接受电话联系。功能恢复通过儿童活动量表-表现进行测量，参与者报告与腕部损伤相关的医疗保健干预措施和费用。主要结局是比较两组在 3 周时的表现评分。
我们共纳入了 149 名平均年龄为 9.5 岁（标准差 2.7 岁）的患者，其中 81 名（54.4%）为男性患者。在 133 名（89.3%）完成 3 周随访的患者中，家庭管理组的儿童活动量表-表现评分为 95.4%（n=66），初级保健医生随访组为 95.9%（n=67）（平均差异-0.4%；95%置信区间下限-2.4%）。与初级保健医生随访组相比，家庭管理组在医疗保健方面的平均节省费用为-100.10 美元（95%置信区间-130.0 至-70.20），在患者费用方面节省-28.2 美元（95%置信区间-49.6 至-7.0）。
在桡骨远端扣带骨折患者中，家庭管理在功能恢复方面至少与初级保健医生随访一样有效。实施家庭管理策略还显示出显著的成本节约。
