From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT.
J Am Acad Orthop Surg. 2023 Sep 15;31(18):984-989. doi: 10.5435/JAAOS-D-22-01097. Epub 2023 May 11.
Foot and ankle fractures are common injuries for which patients may need urgent evaluation and care. Many such injuries are managed in emergency departments (EDs), but urgent care facilities may sometimes be an appropriate setting. Understanding which foot and ankle fractures are managed at which facility might help define care algorithms, improve patient experience, and suggest directions for containing costs.
This retrospective cohort study used the 2010 to 2020 M151 PearlDiver administrative database. Adult patients less than 65 years old presenting to EDs and urgent care facilities for foot and ankle fractures were identified using ICD-9 and ICD-10 diagnosis codes, excluding polytrauma, and Medicare patients. Patient/injury variables associated with urgent care utilization relative to ED utilization and utilization trends of urgent care relative to ED were assessed with univariable and multivariable analyses.
From 2010 to 2020, 1,120,422 patients with isolated foot and ankle fractures presented to EDs and urgent care facilities. Urgent care visits evolved from 2.2% in 2010 to 4.4% in 2020 (P , 0.0001). Independent predictors of urgent care relative to ED utilization were defined. In decreasing odds ratios (ORs), these were insurance (relative to Medicaid, commercial OR 8.03), geographic region (relative to Midwest, Northeast OR 3.55, South OR 1.74, West OR 1.06), anatomic location of fracture (relative to ankle, forefoot OR 3.45, midfoot 2.20, hindfoot 1.63), closed fracture (OR 2.20), female sex (OR 1.29), lower ECI (OR 1.11 per unit decrease), and younger age (OR 1.08 per decade decrease) (P , 0.0001 for all).
A small but increasing minority of patients with foot and ankle fractures are managed in urgent care facilities relative to EDs. While patients with certain injury types were associated with increased odds of urgent care relative to ED utilization, the greatest predictors were nonclinical, such as geographic regions and insurance type, suggesting areas for optimizing access to certain care pathways.
III.
足部和踝关节骨折是常见的损伤，患者可能需要紧急评估和护理。许多此类损伤在急诊科（ED）进行治疗，但紧急护理机构有时可能是合适的治疗场所。了解哪些足部和踝关节骨折在哪个机构进行治疗，可能有助于确定治疗方案，改善患者体验，并为控制成本提供方向。
本回顾性队列研究使用了 2010 年至 2020 年的 M151 PearlDiver 管理数据库。使用 ICD-9 和 ICD-10 诊断代码识别在 ED 和紧急护理机构就诊的小于 65 岁的足部和踝关节骨折患者，排除多发创伤和 Medicare 患者。使用单变量和多变量分析评估与 ED 就诊相比，与紧急护理就诊相关的患者/损伤变量以及与 ED 就诊相比，紧急护理就诊的利用趋势。
2010 年至 2020 年，共有 1120422 名孤立性足部和踝关节骨折患者在 ED 和紧急护理机构就诊。紧急护理就诊从 2010 年的 2.2%增加到 2020 年的 4.4%（P ，0.0001）。确定了与 ED 就诊相比，紧急护理就诊的独立预测因素。这些因素按降序排列的优势比（OR）为：保险（与医疗补助相比，商业保险 OR 8.03）、地理位置（与中西部相比，东北地区 OR 3.55，南部 OR 1.74，西部 OR 1.06）、骨折解剖位置（与踝关节相比，前足 OR 3.45，中足 2.20，后足 1.63）、闭合性骨折（OR 2.20）、女性（OR 1.29）、较低的 ECI（每单位降低 1.11）和年龄较小（每十年降低 1.08）（P ，均，0.0001）。
一小部分但在不断增加的足部和踝关节骨折患者在紧急护理机构接受治疗，而不是在 ED 接受治疗。虽然某些损伤类型的患者与 ED 就诊相比，紧急护理就诊的几率更高，但最大的预测因素是非临床因素，如地理位置和保险类型，这表明在优化某些治疗途径的可及性方面还有改进的空间。
III 级。
