Date of Award

January 2024

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jonathan N. Grauer

Abstract

Supracondylar humerus fractures are one of the most common types of pediatric fractures and also one of the most common indications for surgery in the pediatric orthopaedic population. While complication for these fractures remain low, emergency department (ED) visits following the initial injury and/or surgery had not been investigated, and are a healthcare metric of interest. The present study aimed to identify the incidence, risk factors, and reasons for ED visits following supracondylar humerus fractures.

The M157 Pearldiver Mariner Claims dataset was used to identify pediatric patients who presented with these fractures from 2015 – 2021 using International Classification of Disease diagnostic codes. Patients were divided based on whether they utilized the ED within ninety days following their initial injury. Patient characteristics were determined. The trends in annual utilization and timing of ED visits following initial visit were quantified. Predictive factors for utilizing the ED were determined using multivariable logistical regression. Reasons for ED were qualitatively determined.

There were 92,994 patients identified with supracondylar humerus fractures, of which 10,325 (11.1%) utilized the ED within ninety days. Approximately half of all ED visits occurred within the first two weeks following the initial fracture (48.1%).

On multivariable analysis, factors associated with ED utilization following initial management of fracture were (in descending order of odds ratio [OR]): prior history of ED (OR: 2.69), have diabetes (OR: 1.81), underwent surgical intervention (OR: 1.58), have obesity (OR: 1.57), have asthma (OR: 1.57), have Medicaid insurance (OR: 1.29), and younger patients (OR: 1.11 per year decrease).

Within ninety days following initial management for pediatric supracondylar humerus fractures, more than one in every ten patients presented to the ED at least once. The present study highlights the need for monitoring of such patients following their primary injury and/or surgery, and demonstrates that there are specific risk factors for patients who may present to the ED. Future quality improvement programs should emphasize and focus on patients with defined characteristics to reduce avoidable visits.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/14/2027

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