Saturday, March 13, 2004
Femur fracture is the most common orthopaedic trauma injury requiring hospitalization in children, according to a new study presented at a media briefing on Friday.
"More than 84,202 children were admitted for orthopaedic trauma injuries in 1997, with a direct cost of nearly $1 billion in hospital charges," said lead researcher Michael G. Vitale, MD, of Children's Hospital of New York-Presbyterian Hospital. "Fractures of the femur accounted for 21.7 percent of those hospitalizations, followed by fractures of the tibia and/or fibula (21.5 percent), humerus (17 percent) and radius and/or ulna (14.7 percent)."
Pediatric trauma is the leading cause of death and disability in children, accounting for some 11 million hospitalizations, 100,000 permanent disabilities and 15,000 childhood deaths every year in the United States.
Dr. Vitale and his co-authors conducted the study in order to "understand the patterns in which traumatic injuries occur in children." Such an understanding is "vital to the establishment of effective injury prevention programs, as well as adapting therapies to optimize outcomes of those injured," he said.
Using data from a national pediatric inpatient database, the orthopaedic surgeons identified the top ten pediatric orthopaedic trauma injuries requiring hospitalization in U.S. hospitals. In addition to injury types, the researchers looked at trends in the treat-ment of common orthopaedic injuries with respect to differences in children's versus non-children's hospitals.
The population for the study was taken from the Healthcare Cost and Utilization Project's 1997 Kids Inpatient Database, which provides data on all pediatric discharges.
Trends in pediatric trauma
"The trends are somewhat discouraging," Dr. Vitale reported. In spite of widespread safety and prevention efforts in recent years, pediatric orthopaedic trauma injuries are actually increasing.
"The United States has the highest rate of pediatric trauma in the industrialized world, much higher than in Europe," he said. "We're not sure exactly why, but it reflects our highly mechanized society as well as the gravity of urban violence."
Although the overall death rate of children in the United States has generally decreased over the past 20 years, much of that decrease is due to a decline in deaths from natural causes, Dr. Vitale said. "In fact, death rates among certain subpopulations of the national pediatric trauma population, such as firearm injuries, have shown increases in recent years," he said.
Care varies by hospital type
The study revealed that practice patterns varied for certain groups of patients, depending on the type of hospital where the patient was treated.
For each of the most common pediatric orthopaedic trauma conditions, patient care was received more often than not at non-children's hospitals, although evidence of triaging by hospital type was present, the study showed.
And although lengths of stay, charges and outcomes are all better at facilities that specialize in children's care, nearly 70 percent of pediatric vertebral fractures-the orthopaedic injury with the highest mortality rate-were treated at non-children's hospitals.
"This information gives us an opportunity for improved management," Dr. Vitale said.
The study also revealed that treatment for femur fractures at non-children' hospitals was "less evidence-based, less state-of-the-art than at children's hospitals," he reported.
"Clearly, children are best treated either at a children's hospital, trauma center or other facility that sees a lot of injured children," he said. "Unfortunately, though, children's hospitals are not easily accessible in every locality, and many are swamped with huge numbers of trauma patients. It's a matter of how much the system can take.
"Also, with a number of trauma centers closing down and under financial stress, the facilities that are best prepared to treat injured children are actually decreasing in number," he said.
Prevention the best solution
Given the realities of the current system, the best short-term solution is: 1) to develop ways to disseminate the latest technical innovations in pediatric trauma care to non-children's hospitals as quickly as possible, and 2) to focus on injury prevention, according to Dr. Vitale.
Most pediatric trauma deaths are due to falls from a height or motor vehicle accidents, he said. Evidence exists that, with proper application of safety strategies, there could be a significant reduction of childhood deaths from trauma.
"There are still a lot of unrestrained kids in vehicles these days" he said. "Even when parents realize the importance of restraining their children, that doesn't necessarily happen when they're in a taxi on vacation.
"Orthopaedists can be instrumental in prevention of pediatric recreational injuries by participation in patient education, research and programs that promote safe play," he concluded.
Working with Dr. Vitale on the study were Mark A Vitale; Greg J. Galano, BA, and Joshua E Hyman, MD.
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