School of Medicine, New York Medical College, Valhalla, NY, USA.
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Injury. 2023 Dec;54(12):111128. doi: 10.1016/j.injury.2023.111128. Epub 2023 Oct 18.
Healthcare disparities continue to exist in pediatric orthopedic care. Femur fractures are the most common diaphyseal fracture and the leading cause of pediatric orthopedic hospitalization. Prompt time to surgical fixation of femur fractures is associated with improved outcomes.
The objective of this study was to evaluate associations between socioeconomic status and timing of femoral fixation in adolescents on a nationwide level.
The 2016-2020 National Inpatient Sample (NIS) database was queried using International Classification of Disease, 10th edition (ICD-10) codes for repair of femur fractures. Patients between the ages of 10 and 19 years of age with a principal diagnosis of femur fracture were selected. Patients transferred from outside hospitals were excluded. Baseline demographics and characteristics were described. Patients were categorized as poor socioeconomic status (PSES) if they were classified in the Healthcare Cost and Utilization Project's (HCUP) lowest 50th percentile median income household categories and on Medicaid insurance. The primary outcome studied was timing to femur fixation. Delayed fixation was defined as fixation occurring after 24 h of admission. Secondary outcomes included length of stay (LOS) and discharge disposition.
From 2016-2020, 10,715 adolescent patients underwent femur fracture repair throughout the United States. Of those, 765 (7.1 %) underwent late fixation. PSES and non-white race were consistently associated with late fixation, even when controlling for injury severity. Late fixation was associated with decreased rate of routine discharge (p < 0.01), increased LOS (p < 0.01) and increased total charges (p < 0.01).
Patients of PSES or non-white race were more likely to experience delayed femoral fracture fixation. Delayed fixation led to worse outcomes and increased healthcare resource utilization. Research studying healthcare disparities may provide insight for improved provider education, implicit bias training, and comprehensive standardization of care.
儿科骨科护理中仍然存在医疗保健差异。股骨干骨折是最常见的骨干骨折，也是导致儿科骨科住院的主要原因。股骨骨折及时进行手术固定与改善预后有关。
本研究的目的是在全国范围内评估社会经济地位与青少年股骨固定时间之间的关系。
使用国际疾病分类第 10 版 (ICD-10) 代码查询 2016-2020 年全国住院患者样本 (NIS) 数据库，以修复股骨干骨折。选择年龄在 10 至 19 岁之间、主要诊断为股骨干骨折的患者。排除从外院转来的患者。描述了基线人口统计学和特征。如果患者被归类为医疗保健成本和利用项目 (HCUP) 最低 50 百分位中位数收入家庭类别和医疗补助保险，则认为他们处于较差的社会经济地位 (PSES)。研究的主要结果是股骨固定的时间。延迟固定定义为在入院后 24 小时内进行固定。次要结果包括住院时间 (LOS) 和出院去向。
2016-2020 年，全美共有 10715 名青少年患者接受股骨干骨折修复。其中，765 例 (7.1%) 行晚期固定。即使在控制损伤严重程度的情况下，PSES 和非白色人种也始终与晚期固定相关。晚期固定与常规出院率降低 (p<0.01)、住院时间延长 (p<0.01) 和总费用增加 (p<0.01) 相关。
PSES 或非白种人患者更有可能经历延迟的股骨骨折固定。延迟固定导致预后更差，并增加了医疗资源的利用。研究医疗保健差异的研究可能为改善提供者教育、隐性偏见培训和综合标准化护理提供启示。
