Grauberger, J Pediatr Orthop 2020 - Does Shorter Time to Treatment of Pediatric Femur Shaft Fractures Impact Clinical Outcomes?

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Does Shorter Time to Treatment of Pediatric Femur Shaft Fractures Impact Clinical Outcomes?

Grauberger, Milbrandt, et al.·J Pediatr Orthop·2020·15 citations·Retrospective cohort

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Background

Annual rankings by US News and World Report are a widely utilized metric by both health care leaders and patients. One longstanding measure is time to treatment of femur shaft fractures. Hospitals able to provide at least 80% of pediatric patients with an operating room start time within 18 hours of admission to the emergency department score better as part of the overall pediatric orthopaedic ranking. Therefore, it is important to determine whether the 18-hour treatment time for pediatric femur shaft fractures is a clinically meaningful metric.

Methods

A retrospective review of clinical outcomes of 174 pediatric patients (aged below 16 y) with isolated femur shaft fractures (Injury Severity Score=9) was conducted from 1997 to 2017 at a single level I pediatric trauma center. The 2 comparison groups were patients receiving fracture reduction within 18 hours of emergency department admission (N=87) or >18 hours (N=87).

Results

Patient, injury, and surgical characteristics were similar between the 2 groups.
Both groups had a similar mean age (treatment <18 h=7.5 y; treatment >18 h=8.1 y).
Patients who received treatment within 18 hours were more often immobilized postoperatively (70.1% vs. 53.5%; P =0.0362) and had a shorter median hospital length of stay (2 vs. 3 d; P =0.0047).
There were no statistically significant differences in any outcomes including surgical site infection, time to weight-bearing (treatment <18 h mean=48.1 d vs. 52.5 d), time to complete radiographic fracture healing (treatment <18 h mean=258.9 d vs. 232.0 d), decreased range of motion, genu varus/valgus, limb length discrepancy, loss of reduction, or persistent pain.

Conclusions

Treatment of pediatric femur shaft fractures within 18 hours does not impact clinical outcomes. National quality measures should therefore use evidence-based metrics to help improve the standard of care.

Level of evidence: Therapeutic level III. Copyright remains with the authors and publisher.

Does Shorter Time to Treatment of Pediatric Femur Shaft Fractures Impact Clinical Outcomes?

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Does Shorter Time to Treatment of Pediatric Femur Shaft Fractures Impact Clinical Outcomes?

Grauberger, Milbrandt, et al.·J Pediatr Orthop·2020·15 citations·Retrospective cohort

Free Full Text·DOI·PubMed

|

Background

Annual rankings by US News and World Report are a widely utilized metric by both health care leaders and patients. One longstanding measure is time to treatment of femur shaft fractures. Hospitals able to provide at least 80% of pediatric patients with an operating room start time within 18 hours of admission to the emergency department score better as part of the overall pediatric orthopaedic ranking. Therefore, it is important to determine whether the 18-hour treatment time for pediatric femur shaft fractures is a clinically meaningful metric.

Methods

A retrospective review of clinical outcomes of 174 pediatric patients (aged below 16 y) with isolated femur shaft fractures (Injury Severity Score=9) was conducted from 1997 to 2017 at a single level I pediatric trauma center. The 2 comparison groups were patients receiving fracture reduction within 18 hours of emergency department admission (N=87) or >18 hours (N=87).

Results

Patient, injury, and surgical characteristics were similar between the 2 groups.
Both groups had a similar mean age (treatment <18 h=7.5 y; treatment >18 h=8.1 y).
Patients who received treatment within 18 hours were more often immobilized postoperatively (70.1% vs. 53.5%; P =0.0362) and had a shorter median hospital length of stay (2 vs. 3 d; P =0.0047).
There were no statistically significant differences in any outcomes including surgical site infection, time to weight-bearing (treatment <18 h mean=48.1 d vs. 52.5 d), time to complete radiographic fracture healing (treatment <18 h mean=258.9 d vs. 232.0 d), decreased range of motion, genu varus/valgus, limb length discrepancy, loss of reduction, or persistent pain.

Conclusions

Treatment of pediatric femur shaft fractures within 18 hours does not impact clinical outcomes. National quality measures should therefore use evidence-based metrics to help improve the standard of care.

Level of evidence: Therapeutic level III. Copyright remains with the authors and publisher.

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