Kowblansky Adrianna, Fealy Andrew, Dance Sarah, Mansour Adam, Cleary Kevin, Tabaie Sean A
Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Orthopedic Surgery, Children's National Hospital, Washington DC, USA.
Cureus. 2025 May 30;17(5):e85103. doi: 10.7759/cureus.85103. eCollection 2025 May.
Background Forearm fractures represent approximately 20% of pediatric fractures and are commonly managed in emergency departments (EDs). While minimally displaced fractures require immobilization, displaced fractures necessitate reduction. Many non-pediatric facilities lack the resources to manage these fractures, leading to frequent transfers to pediatric emergency departments (PEDs). This study aims to evaluate the rate of avoidable transfers of pediatric forearm fractures to a PED and identify risk factors contributing to unnecessary transfers. Methods A retrospective cross-sectional study was conducted at a single tertiary pediatric hospital from July 1, 2022, to June 30, 2023. Patients aged 0-17 years treated for forearm fractures were identified using ICD-10 codes. Exclusion criteria included patients not transferred, incomplete treatment data, or missing initial radiographs. Collected variables encompassed demographics, fracture characteristics, transfer details, and treatments performed. Statistical analyses included chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables, with significance set at p < 0.05. Results Out of 445 patients identified, 161 met the inclusion criteria. The mean age was 8.0 years (SD 3.9); 70.8% were male, and 31.7% were African Americans. Avoidable transfers, defined as patients who did not require reduction or surgical intervention, accounted for 38 cases (23.6%). Non-displaced fractures were significantly associated with avoidable transfers (p < 0.001). Race was also significant, with higher rates of avoidable transfer among African American patients (42.1%) and patients of other races (47.4%) compared to Caucasian patients (10.5%) (p = 0.006). There was a statistically significant association between the source of appropriate and avoidable transfers (p = 0.012), with cases originating from clinics (n = 7), outside hospitals (n = 24), and urgent care centers (n = 7). Multivariate logistic regression identified younger age as the only significant factor associated with avoidable transfer (p = 0.047, OR: 0.74, CI: 0.5-0.98). Conclusions A significant proportion of pediatric forearm fracture transfers to the PED were avoidable, primarily due to patients not requiring reduction or surgical intervention. Younger age was a significant factor associated with unnecessary transfers. Enhancing education on pediatric fracture management and establishing clear guidelines may reduce unnecessary transfers, optimize resource utilization, and alleviate burdens on specialized centers.
前臂骨折约占儿童骨折的20%，通常在急诊科进行处理。对于轻度移位骨折，需要进行固定；而对于移位骨折，则需要进行复位。许多非儿科医疗机构缺乏处理这些骨折的资源，导致频繁转诊至儿科急诊科（PED）。本研究旨在评估儿童前臂骨折转诊至PED的可避免率，并确定导致不必要转诊的风险因素。方法：于2022年7月1日至2023年6月30日在一家三级儿科专科医院进行了一项回顾性横断面研究。使用ICD-10编码识别0至17岁因前臂骨折接受治疗的患者。排除标准包括未转诊的患者、治疗数据不完整或缺少初始X光片的患者。收集的变量包括人口统计学、骨折特征、转诊细节和所进行的治疗。统计分析包括对分类变量的卡方检验和对连续变量的曼-惠特尼U检验，显著性设定为p < 0.05。结果：在识别出的445例患者中，161例符合纳入标准。平均年龄为8.0岁（标准差3.9）；70.8%为男性，31.7%为非裔美国人。可避免转诊定义为不需要复位或手术干预的患者，占38例（23.6%）。非移位骨折与可避免转诊显著相关（p < 0.001）。种族也具有显著性，与白人患者（10.5%）相比，非裔美国患者（42.1%）和其他种族患者（47.4%）的可避免转诊率更高（p = 0.006）。适当转诊和可避免转诊的来源之间存在统计学显著关联（p = 0.012），病例分别来自诊所（n = 7）、外部医院（n = 24）和紧急护理中心（n = 7）。多因素逻辑回归分析确定年龄较小是与可避免转诊相关的唯一显著因素（p = 0.047，OR：0.74，CI：0.5 - 0.98）。结论：儿童前臂骨折转诊至PED的很大一部分是可避免的，主要原因是患者不需要复位或手术干预。年龄较小是与不必要转诊相关的显著因素。加强儿童骨折管理教育并制定明确的指南可能会减少不必要的转诊，优化资源利用，并减轻专科中心的负担。
