需要在不同医疗机构间转运的肱骨髁上骨折的治疗差异。

Differences in Treatment of Supracondylar Humerus Fractures Requiring Transfer Between Facilities.

作者信息

Nihalani Shrey, Reeves Harrison, Lane Pearce, Padgett Mack, Mcgwin Gerald, Conklin Michael J, Williams Kevin A

机构信息

Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.

出版信息

J Pediatr Soc North Am. 2024 Dec 9;10:100141. doi: 10.1016/j.jposna.2024.100141. eCollection 2025 Feb.

DOI:10.1016/j.jposna.2024.100141

PMID:40433575

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12088252/

Abstract

PURPOSE

The current study aims to elucidate the differences in the timing of the management of operative supracondylar humerus fractures (SCHF) based on whether or not the patient is transferred between facilities.

METHODS

This was a prospective cohort study of patients with surgically treated SCHF conducted at a level I pediatric trauma center. The management of these fractures was compared based on their presenting facility (pediatric trauma center versus another facility). Primary outcomes were time to orthopaedic consult, time to surgery, need for open reduction, and operative times. Secondary outcomes include the need for repeat imaging, transfer time, transfer vehicle, and transfer distance.

RESULTS

A total of 146 (78 female) patients with an average age of 5.70 (±2.12) years were included in the study. Time from initial presentation to orthopaedic consult ( < 0.001) and time from initial presentation to surgery ( = 0.006) was shorter for Children's hospital patients compared to outside facility patients. Repeat radiographs were more common when patients presented to outside facilities compared to children's hospital ( < 0.001). Operative times were the same for both groups (31 min children's hospital, 32 min outside facility). Patients arriving from the outside facility via ambulance traveled further in comparison to those arriving via private vehicle ( = 0.009) but had a shorter time to operation ( = 0.002).

CONCLUSIONS

Efficient processes and collaboration between healthcare facilities to ensure timely and effective care for pediatric patients with SCHF are essential. Patients from outside facilities experienced longer times to orthopaedic consult and surgery while having similar baseline characteristics.

KEY CONCEPTS

(1)Patients arriving from outside facilities had an overall longer time to orthopaedic consult and definitive fixation.(2)There was no difference in the need for open reduction or the operative time based on the patient's presenting facility.(3)Transferred patients often underwent repeat imaging prior to consult.

LEVEL OF EVIDENCE

II.

摘要

目的

本研究旨在阐明基于患者是否在不同医疗机构间转运，手术治疗肱骨髁上骨折（SCHF）的处理时机差异。

方法

这是一项在一级儿童创伤中心对接受手术治疗的SCHF患者进行的前瞻性队列研究。根据患者的就诊机构（儿童创伤中心与其他机构）比较这些骨折的处理情况。主要结局指标为骨科会诊时间、手术时间、切开复位需求及手术时长。次要结局指标包括重复影像学检查需求、转运时间、转运工具及转运距离。

结果

本研究共纳入146例患者（78例女性），平均年龄5.70（±2.12）岁。与来自其他机构的患者相比，儿童医院患者从初次就诊到骨科会诊的时间（<0.001）以及从初次就诊到手术的时间（=0.006）更短。与儿童医院相比，患者在其他机构就诊时重复进行X线检查更为常见（<0.001）。两组的手术时长相同（儿童医院31分钟，其他机构32分钟）。与乘坐私家车前来的患者相比，乘坐救护车从其他机构前来的患者路途更远（=0.009），但手术时间更短（=0.002）。