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It's Ok to Delay, But at What Cost? A Review of Pediatric Supracondylar Fracture Management
Anna Goldenberg-Sandau, DO, Joseph Gannett, BS, Joshua P. Hazelton, DO, FACS, FACOS, Nicole Fox, MD, MPH, FACS. Cooper University Hospital, Camden NJ, USA.

Background: Supracondylar humerus fractures (SCF) in children have historically been treated as surgical emergencies. Recent literature indicates that non-emergent repair (NER) of the "perfused but pulseless SCF" is acceptable and, based on this, our institutional guidelines were modified. We subsequently performed an institutional review of SCF management to evaluate the impact of NER.

Methods: A retrospective chart review of patients (<18yrs) admitted with SCF (2010-2015) was conducted. Demographics, clinical characteristics, costs, and outcome data were collected. Categorical variables were compared using Fisher exact test and Wilcoxon rank sum test.

Results: Patients (n=68) admitted from 2010-2012 (n=30) were compared to those admitted 2013-2015 (n=38) following the guideline change. There were no differences in age, gender, race, mechanism of injury, ISS, fracture type, neurologic or vascular symptoms, or complications between the two groups (all p>0.05). Length of stay (LOS) was longer (2.5d vs 1.8d) and direct costs per encounter were higher ($44042720 vs $2420700) (all p< 0.005) in the NER group. Admissions to the pediatric intensive care and intermediate units were more frequent in the NER group (21% vs 0%; p<0.003). Time to surgery was not statistically significant between the two groups (11.09.6hr vs 1512.6hr; p=0.13).

Conclusions: Our results indicate that NER of pediatric SCF results in increased hospital LOS, resource utilization, and overall costs with no difference in clinical outcomes. With an increasing pressure to deliver high quality care at the lowest possible cost, it is important to consider the overall impact of practice changes on the healthcare system.

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