Rana Parimal, Brennan Jane, Johnson Andrea, Donegan Caroline, Gelfand Jake, Spirt Adrienne, Keblish David, Turcotte Justin, Friedmann Elizabeth
Department of Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA.
Foot Ankle Spec. 2024 May 10:19386400241249807. doi: 10.1177/19386400241249807.
Foot and ankle fractures present common challenges in emergency departments, warranting careful follow-up protocols for optimal patient outcomes. This study investigates the predictors of orthopaedic follow-up for these injuries after an emergency department (ED) visit.
A retrospective observational study of 1450 patients seen in the ED with foot or ankle fractures from July 2015 to February 2023 was conducted. All included patients were discharged with instructions to follow-up with an orthopaedic provider. Demographic data, fracture details, and follow-up patterns were extracted from medical records. Social vulnerability was assessed using the Centers for Disease Control (CDC) Social Vulnerability Index. Univariate and multivariate analyses were performed to identify predictors of follow-up. A subgroup analysis comparing patients who followed up >7 days from ED presentation (ie, delayed follow-up) to those who followed up within 7 days of presentation was then performed. Statistical significance was assessed at P < .05.
Overall, 974/1450 (67.2%) patients followed up with orthopaedics at an average time of 4.16 days. After risk adjustment, Medicaid coverage (odds ratio [OR] = 0.56, P = .018), increased overall social vulnerability (OR = 0.83, P = .032), and increased vulnerability across the dimensions of socioeconomic status (P = .002), household characteristics (P = .034), racial and ethnic minority status (P = .007), and household type and transportation (P = .032) were all associated with lower odds of follow-up. Phalangeal fractures were also associated with decreased odds of follow-up (OR = 0.039, P < .001), whereas ankle fractures were more likely to follow-up (OR = 1.52, P = .002). In the subgroup analysis, patients of older age (P = .008), non-white race (P = .024), motor vehicle accident (MVA) (P = .027) or non-private insurance (P = .027), those experiencing phalangeal fractures (P = .015), and those seen by an orthopaedic provider in the ED (P = .006) were more likely to present with delayed follow-up.
Patients with increased social vulnerability and Medicaid insurance are less likely to seek follow-up care after presentation to the ED with foot and ankle fractures.
足踝部骨折在急诊科是常见的挑战，需要制定仔细的随访方案以实现最佳的患者预后。本研究调查了急诊科就诊后这些损伤进行骨科随访的预测因素。
对2015年7月至2023年2月在急诊科就诊的1450例足踝部骨折患者进行回顾性观察研究。所有纳入患者出院时均收到随访骨科医生的指示。从病历中提取人口统计学数据、骨折细节和随访模式。使用疾病控制中心（CDC）社会脆弱性指数评估社会脆弱性。进行单因素和多因素分析以确定随访的预测因素。然后进行亚组分析，比较急诊就诊后>7天随访的患者（即延迟随访）与就诊后7天内随访的患者。P <.05时评估统计学显著性。
总体而言，974/1450（67.2%）例患者进行了骨科随访，平均随访时间为4.16天。风险调整后，医疗补助覆盖（比值比[OR]=0.56，P =.018）、整体社会脆弱性增加（OR =0.83，P =.032）以及社会经济地位（P =.002）、家庭特征（P =.034）、种族和少数民族地位（P =.007）以及家庭类型和交通方面的脆弱性增加（P =.032）均与随访几率降低相关。趾骨骨折也与随访几率降低相关（OR =0.039，P <.001），而踝关节骨折更有可能进行随访（OR =1.52，P =.002）。在亚组分析中，年龄较大（P =.008）、非白人种族（P =.024）、机动车事故（MVA）（P =.027）或非私人保险（P =.027）的患者、发生趾骨骨折的患者（P =.015）以及在急诊科由骨科医生诊治的患者（P =.006）更有可能出现延迟随访。
社会脆弱性增加且有医疗补助保险的患者在急诊科就诊足踝部骨折后寻求后续治疗的可能性较小。
