Boston Children's Hospital and Harvard Medical School, MA, USA.
Hand (N Y). 2023 Mar;18(2):288-293. doi: 10.1177/15589447211008590. Epub 2021 Apr 24.
Although pediatric hand fractures are common and generally have good outcomes, they remain a considerable source of anxiety for non-hand surgeons, who are less familiar with these injuries. We hypothesized that this anxiety may manifest as inefficiency in referral patterns.
The records of pediatric patients with isolated, closed hand fractures without concurrent trauma seen at our institution by a hand surgeon between January 2017 and December 2018 were retrospectively reviewed.
There were 454 patients included; 62.1% were men, and the mean age was 9.6 years at initial encounter. Most patients (89.6%) were treated nonoperatively and incurred few complications (0.5%). Roughly half of all cases (n = 262) initially presented to an outside provider. Of these, 24.0% (n = 64 of 262) were evaluated by 2+ providers before a hand surgeon. Most commonly, these patients were referred from an outside emergency department (ED) to our ED before hand surgeon evaluation (n = 45 of 64). Forty-seven patients required surgery; however, none were performed urgently. Although a greater proportion of 7- to 11-year-old patients saw 2+ providers prior to a hand surgeon ( = .007), fewer required surgery ( < .001).
Pediatric closed hand fractures are mainly treated nonoperatively and nonemergently with generally excellent outcomes. Our data suggest that many patients continue to be referred through the ED or multiple EDs/providers for treatment. These inefficient referral patterns demonstrate the need for better education for ED and primary care providers, as well as better communication between these providers and local pediatric hand surgeons. Advancements in these areas are likely to improve efficiency of care and decrease costs.
尽管小儿手部骨折较为常见，且通常预后良好，但对于不太熟悉这些损伤的非手外科医生来说，它们仍然是一个相当大的焦虑源。我们假设这种焦虑可能表现为转诊模式的效率低下。
回顾性分析了 2017 年 1 月至 2018 年 12 月我院手外科医生诊治的 454 例单纯闭合性手部无伴发外伤的小儿患者的病历。
454 例患者中，62.1%为男性，初次就诊时的平均年龄为 9.6 岁。大多数患者（89.6%）接受非手术治疗，并发症很少（0.5%）。大约一半的病例（n=262）最初由外部医生就诊。其中，24.0%（n=262 例中的 64 例）在接受手外科医生评估前由 2 名以上医生进行了评估。这些患者最常见的转诊情况是从外部急诊室（ED）到我院 ED，然后再到手外科医生处（n=45/64）。47 例患者需要手术，但均非紧急手术。虽然 7-11 岁患者在接受手外科医生治疗前接受 2 名以上医生评估的比例较高（=0.007），但需要手术的患者较少（<0.001）。
小儿闭合性手部骨折主要采用非手术治疗，通常为非紧急治疗，且预后良好。我们的数据表明，许多患者仍通过急诊室或多个急诊室/医生转诊治疗。这些效率低下的转诊模式表明需要加强对急诊室和初级保健提供者的教育，以及加强这些提供者与当地小儿手外科医生之间的沟通。在这些方面的改进可能会提高护理效率并降低成本。
