Sborov Katherine D, Haruno Lee S, Raszka Samuel, Poon Selina C
Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA.
Shriners Children's Southern California, 909 S. Fair Oaks Ave, Pasadena, CA, 91105, USA.
Curr Rev Musculoskelet Med. 2023 Oct;16(10):488-492. doi: 10.1007/s12178-023-09860-0. Epub 2023 Aug 7.
This article provides a review of recent published research studying racial, ethnic, and socioeconomic disparities in pediatric musculoskeletal care.
Disparities in pediatric musculoskeletal care are demonstrated in two general realms: access to care and health outcomes. Though initiatives have been proposed or enacted to address disparities, underrepresented minorities and patients from lower socioeconomic statuses continue to face barriers across the spectrum of orthopedic care and poorer ultimate outcomes after both non-operative and operative management. Minority pediatric patients and those from lower socioeconomic statuses experience delays across the spectrum of orthopedic care for both urgent and non-urgent conditions. They wait longer between injury date and initial orthopedic evaluation, longer to receipt of diagnostic imaging, and longer to ultimate treatment than their counterparts. When finally able to obtain musculoskeletal care and treatment, they are at higher risk of poor in-hospital outcomes and inpatient complications, worse patient reported outcomes, and suboptimal pain management. In the outpatient setting, they receive less physical therapy and follow-up clinic visits, resulting in greater stiffness and strength deficits, and are ultimately less likely to meet return to sport criteria.
本文对近期发表的关于儿童肌肉骨骼疾病治疗中种族、民族和社会经济差异的研究进行综述。
儿童肌肉骨骼疾病治疗差异体现在两个主要方面:获得治疗的机会和健康结局。尽管已提出或实施了一些举措来解决差异问题,但少数族裔和社会经济地位较低的患者在整个骨科治疗过程中仍然面临障碍,并且在非手术和手术治疗后的最终结局较差。少数族裔儿童患者和社会经济地位较低的患者在紧急和非紧急情况下的整个骨科治疗过程中都会出现延迟。与同龄人相比,他们在受伤日期与首次骨科评估之间等待的时间更长,接受诊断性影像学检查的时间更长,接受最终治疗的时间也更长。当最终能够获得肌肉骨骼疾病的治疗时,他们住院结局不佳和住院并发症的风险更高,患者报告的结局更差,疼痛管理也不理想。在门诊环境中,他们接受的物理治疗和随访门诊就诊较少,导致僵硬和力量缺陷更大,最终达到恢复运动标准的可能性也更小。