Pediatric Supracondylar Humerus Fracture AAOS Appropriate Use Criteria: Does Treatment at a Pediatric Level I Trauma Center Comply?

BACKGROUND

The primary purpose of this analysis was to compare supracondylar humerus fracture (SCHF) treatment patterns at a single quaternary pediatric hospital relative to the American Academy of Orthopedic Surgeons (AAOS) appropriate use treatment recommendation(s).

METHODS

Among all fractures included in the cohort (n=571), the observed treatment approach was evaluated relative to the AAOS "Appropriate" treatment recommendation(s). The proportion, and corresponding 95% confidence interval, of cases that agreed with the "Appropriate" treatment recommendation was estimated. Demographics and clinical characteristics among cases that were managed in accordance with the "Appropriate," "May be Appropriate," or "Rarely Appropriate" were compared.

RESULTS

All fractures were treated according to the "Appropriate," "May be Appropriate," or "Rarely Appropriate" AAOS treatment guidelines. The observed treatment among fractures included in the cohort agreed with AAOS "Appropriate" recommendations in 92.1% [95% confidence interval (CI): 89.6%-94.2%] of the cases. Fracture type differed significantly between patients treated according to AAOS "Appropriate" recommendations compared to those treated according to "May be Appropriate," or "Rarely Appropriate" recommendation.

CONCLUSIONS

The treatment approach implemented at a single level 1 trauma center was in concordance with the appropriate use criteria treatment recommendations in a significant majority of cases. Fractures not treated according to "Appopriate" recommendations were primarily type IIA injuries, and were treated with closed reduction and casting instead of the recommended closed reduction and percutaneous pinning.

LEVEL OF EVIDENCE

Level III.