脑瘫儿童骨折与短期不良健康结局的关系。
The association between fracture and short-term adverse health outcomes among children with cerebral palsy.
机构信息
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
出版信息
Bone. 2024 Dec;189:117267. doi: 10.1016/j.bone.2024.117267. Epub 2024 Oct 2.
BACKGROUND
Children with cerebral palsy (CP) have a high risk of fracture; yet, little is known about their post-fracture health outcomes. A fracture is an unplanned event in contrast to surgeries or procedures where there is a pre-operative period to optimize body composition and health and planned post-operative follow-up care. Fractures may be associated with significant outcomes due to the unplannable nature and reactionary care. The objective of this study was to determine if fractures were associated with an increased rate of short-term adverse health outcomes among children with CP, and if these associations were dependent on age.
METHODS
This retrospective cohort study used commercial claims from 01/01/2001-12/31/2018. The primary cohort was children 2-18 years old with CP and an incident fracture (CP + Fx). Comparison cohorts were propensity score matched 1:1 to CP + Fx on demographic and health-related indicators: CP without fractures (CPw/oFx); without CP with (w/oCP + Fx) or without (w/oCPw/oFx) a fracture. The incidence rate (IR) and IR ratios (IRR) of 30-day and 31-90-day pneumonia and 90-day emergency department (ED) visit were estimated. Cox regression tested for effect modification by age and sex.
RESULTS
The CP + Fx cohort (n = 1670) had higher IRs of 30-day pneumonia (IRR range, 1.53-4.54) and 90-day ED visit (IRR range, 1.45-2.37) (all P < 0.05), and higher IRs of 31-90-day pneumonia but this did not reach statistical significance (IRR, 1.41 to 2.32, all P > 0.05). Notably, there was evidence of effect modification by age. The rate of 30-day pneumonia became more problematic for CP + Fx with older age relative to comparison cohorts and for 90-day ED visit compared to CPw/oFx. The rate of 90-day ED visit for CP + Fx was more problematic at younger ages compared to w/oCP + Fx.
CONCLUSIONS
Fractures among children with CP were associated with an increased rate of short-term pneumonia and ED visit, which was more problematic with older age.
背景
脑瘫儿童（CP）骨折风险较高；然而，人们对他们骨折后的健康结果知之甚少。骨折是一种意外事件，而手术或程序则不同，手术或程序有术前阶段来优化身体成分和健康状况，并计划术后随访护理。由于不可预测性和反应性护理，骨折可能会导致严重的后果。本研究的目的是确定骨折是否与 CP 儿童短期不良健康结果的发生率增加有关，以及这些关联是否取决于年龄。
方法
这是一项回顾性队列研究，使用了 2001 年 1 月 1 日至 2018 年 12 月 31 日的商业索赔数据。主要队列为 2-18 岁患有 CP 和骨折（CP+Fx）的儿童。CP 无骨折（CPw/oFx）、无 CP 骨折（w/oCP+Fx）或无 CP 无骨折（w/oCPw/oFx）的 1:1 倾向评分匹配队列被作为对照。30 天和 31-90 天肺炎以及 90 天急诊就诊的发生率（IR）和发生率比（IRR）进行了估计。Cox 回归检验了年龄和性别对效应修饰的影响。
结果
CP+Fx 队列（n=1670）30 天肺炎（IRR 范围 1.53-4.54）和 90 天急诊就诊（IRR 范围 1.45-2.37）的 IR 较高（均 P<0.05），以及 31-90 天肺炎的 IR 较高，但无统计学意义（IRR 为 1.41 至 2.32，均 P>0.05）。值得注意的是，年龄存在效应修饰的证据。与对照队列相比，CP+Fx 年龄较大时，30 天肺炎的发生率问题更为严重，与 CPw/oFx 相比，90 天急诊就诊的发生率问题更为严重。与 w/oCP+Fx 相比，CP+Fx 在年龄较小的儿童中，90 天急诊就诊的发生率问题更为严重。
结论
CP 儿童骨折与短期肺炎和急诊就诊发生率增加有关，且年龄越大问题越严重。
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