Sanborn Ryan M, Bauer Andrea S, Miller Patricia E, Kramer Dennis E, May Collin J, Vuillermin Carley B, Yen Yi-Meng
Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Child Orthop. 2022 Apr;16(2):104-110. doi: 10.1177/18632521221087174. Epub 2022 Apr 30.
The purpose of this study was to quantify the anxiety experienced by patients undergoing pin removal in clinic following closed reduction and percutaneous pinning for supracondylar humerus fractures.
We prospectively enrolled 53 patients (3-8 years) treated for supracondylar humerus fracture with closed reduction and percutaneous pinning between July 2018 and February 2020. Demographic and injury data were recorded. Heart rate and the Face, Legs, Activity, Cry, and Consolability scale were measured immediately before pin removal and after pin removal, and crossover control values were obtained at the subsequent follow-up clinic visit.
All patients experienced anxiety immediately prior to pin removal (95% confidence interval, 94%-100%) with a median Face, Legs, Activity, Cry, and Consolability score of 7 (interquartile range, 6-8). In addition, 98% of subjects experienced an elevated heart rate (95% confidence interval, 88%-100%). Patients experienced a median 73% reduction in Face, Legs, Activity, Cry, and Consolability score and mean 21% reduction in heart rate from prior to pin removal to after pin removal ( < 0.001). All 45 patients who completed their follow-up visit had a control Face, Legs, Activity, Cry, and Consolability score of 0 and a mean control heart rate of 89.7 bpm. Twenty-five of these 45 subjects (56%) had an elevated control heart rate for their age and sex. Mean heart rate prior to pin removal was 36% higher than control heart rate. There were no sex differences detected in Face, Legs, Activity, Cry, and Consolability scores or heart rate.
Pediatric patients experience high levels of anxiety when undergoing pin removal following closed reduction and percutaneous pinning for supracondylar humerus fractures. This is an area of clinical practice where intervention may be warranted to decrease patient anxiety.
II.
本研究旨在量化在门诊接受闭合复位经皮穿针治疗肱骨髁上骨折后取针的患者所经历的焦虑程度。
我们前瞻性纳入了2018年7月至2020年2月期间接受闭合复位经皮穿针治疗肱骨髁上骨折的53例患者（3 - 8岁）。记录人口统计学和损伤数据。在取针前和取针后立即测量心率以及面部、腿部、活动、哭闹和安慰度量表评分，并在随后的随访门诊就诊时获取交叉对照值。
所有患者在取针前均经历焦虑（95%置信区间，94% - 100%），面部、腿部、活动、哭闹和安慰度量表评分中位数为7（四分位间距，6 - 8）。此外，98%的受试者心率升高（95%置信区间，88% - 100%）。从取针前到取针后，患者面部、腿部、活动、哭闹和安慰度量表评分中位数降低73%，心率平均降低21%（<0.001）。完成随访就诊的所有4五个患者面部、腿部、活动、哭闹和安慰度量表评分对照值为0，平均对照心率为89.7次/分。这45例受试者中有25例（56%）其对照心率高于同年龄和性别的正常水平。取针前平均心率比对照心率高36%。在面部、腿部、活动、哭闹和安慰度量表评分或心率方面未检测到性别差异。
小儿患者在接受闭合复位经皮穿针治疗肱骨髁上骨折后取针时会经历高度焦虑。这是临床实践中一个可能需要进行干预以降低患者焦虑的领域。
II级
