From the Division of Emergency Medicine.
Pediatr Emerg Care. 2022 Jul 1;38(7):e1342-e1347. doi: 10.1097/PEC.0000000000002752. Epub 2022 Jun 8.
Fractures are common childhood injuries that result in emergency department (ED) visits. National trends in pediatric fracture epidemiology and resource utilization are not well described. Our objective is to analyze national trends in pediatric fracture epidemiology, ED disposition, and ED resource utilization from 2010 to 2015.
This is an epidemiological study of fracture care in US EDs from 2010 to 2015 for children 0 to 18 years old using the Nationwide Emergency Department Sample. We calculated frequencies and national rates using weighted analyses and census data. We used the test for linear trend to analyze incidence, hospital admission, transfer, and procedural sedation over time. Multivariate logistic regression analyses identified encounter- and hospital-level predictors of transfer, admission, operative care, and use of procedural sedation.
During the study period, from 2010 to 2015, a total of 5,398,827 children received ED care for fractures. The pediatric fracture rate was 11.5 ED visits/1000 persons (95% confidence interval [CI], 10.6-12.5) and decreased over time. The admission rate for pediatric fracture patients was 5% and stable over time. The transfer rate increased from 3.3 to 4.1/100 fracture visits (linear trend: odds ratio, 1.06; 95% CI, 1.03-1.09). Utilization of procedural sedation increased from 1.5% to 2.9% of fracture visits (linear trend: odds ratio, 1.17; 95% CI, 1.09-1.25). Predictors associated with disposition and resource utilization include patient age, fracture location, insurance type, hospital type, and region.
The national incidence rate of pediatric fractures decreased slightly. Emergency department resource utilization increased over time. With high national volume, understanding pediatric fracture epidemiology and resource utilization is important to the health care system.
骨折是常见的儿童外伤，会导致儿童前往急诊科就诊。目前，全国范围内有关儿科骨折流行病学和资源利用的趋势尚不清楚。本研究旨在分析 2010 年至 2015 年期间，美国儿童急诊科骨折的流行病学、处置方式和急诊科资源利用的变化趋势。
这是一项使用全国急诊科抽样调查（NEDS）数据的 2010 年至 2015 年期间美国儿童急诊科骨折的流行病学研究。我们采用加权分析和人口普查数据计算了频率和全国发生率。采用线性趋势检验分析了发病率、住院、转科和程序性镇静的时间变化趋势。多变量逻辑回归分析确定了与转科、住院、手术治疗和程序性镇静使用相关的就诊和医院水平预测因素。
在研究期间（2010 年至 2015 年），共有 5398827 名儿童因骨折到急诊科就诊。儿科骨折发生率为 11.5 次/1000 人（95%置信区间，10.6-12.5），且呈逐渐下降趋势。儿童骨折患者的住院率为 5%，且较为稳定。骨折患儿的转科率从 3.3%升至 4.1%/100 例骨折（线性趋势：比值比，1.06；95%置信区间，1.03-1.09）。程序性镇静的使用率从 1.5%升至 2.9%/100 例骨折（线性趋势：比值比，1.17；95%置信区间，1.09-1.25）。与处置方式和资源利用相关的预测因素包括患者年龄、骨折部位、保险类型、医院类型和地区。
全国范围内儿童骨折的发生率略有下降。急诊科资源的利用率随时间增加。鉴于全国范围内的高发病率，了解儿科骨折的流行病学和资源利用情况对医疗保健系统非常重要。
