Transfers of pediatric patients with isolated injuries to a rural Level 1 Orthopedic Trauma Center in the United States: are they all necessary?

Smithson, Kaleb; Parham, Sean G; Mears, Simon C.; Siegel, Eric R.; Crawley, Lee; Sachleben, Brant

doi:10.1007/s00402-020-03679-x

Cited by 3 publications

(6 citation statements)

References 28 publications

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“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have found that a major proportion of orthopaedic injury patients visiting outpatient clinics and emergency rooms only require basic care and are discharged without the need for specialist consultation arising. 29 , 30 , 31 Telemedicine-based care saves both cost and time in managing such patients. Telemedicine has emerged as an effective screening tool to categorise patients who require virtual consultation only and those who require physical evaluation.…”

Section: Discussionmentioning

confidence: 99%

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Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

Kumar

Sinha

Jameel

et al. 2022

Journal of Taibah University Medical Sciences

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Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

Kumar

Sinha

Jameel

et al. 2022

Journal of Taibah University Medical Sciences

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“…Many emergency departments are now referring pediatric fractures directly to specialized pediatric emergency departments, whereas, in previous years, such institutions may have opted to manage these injuries themselves, leading to increasing care by pediatric orthopaedic specialists over recent years. 17,18 These transfer centers may have played a large role in shifting the paradigm of treatment of pediatric orthopaedic injuries towards more subspecialized surgeons at tertiary referral centers. For example, Holt et al 19 showed that transfer rates of pediatric patients with supracondylar humerus fractures had significantly increased from 2006 to 2011.…”

Section: Discussionmentioning

confidence: 99%

“…Ultimately, further studies would be useful to evaluate whether or not pediatric orthopaedists are treating more fractures surgically that would otherwise be treated with closed reduction and casting, or if they are simply receiving more referrals due to increasing subspecialization and the increased prevalence of "referral centers" for pediatric orthopaedic injuries. 17,18 Using a national inpatient database, a recent study noted an increase from 59.3% to 70% in the surgical management of pediatric forearm fractures between 2000 to 2012. 5 Flynn et al's 3 report from 2012 noted that over 11 years, the mean percentage of pediatric forearm fracture patients treated operatively increased from 1.4% to 10.4%.…”

Section: Discussionmentioning

confidence: 99%

“…Another important contributor to these findings relates to recent trends in emergency room referral patterns. Many emergency departments are now referring pediatric fractures directly to specialized pediatric emergency departments, whereas, in previous years, such institutions may have opted to manage these injuries themselves, leading to increasing care by pediatric orthopaedic specialists over recent years 17,18. These transfer centers may have played a large role in shifting the paradigm of treatment of pediatric orthopaedic injuries towards more subspecialized surgeons at tertiary referral centers.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Operative Treatment of Pediatric and Adolescent Forearm Fractures Among American Board of Orthopaedic Surgery Part II Candidates

Testa

Pérez

Tran

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Pediatric and adolescent forearm fractures are among the most common injuries treated by orthopaedic surgeons. Recent literature shows that there has been an increased interest in operative management for these injuries. The purpose of the current study was to examine the trends in case volume, patient age, surgeon fellowship training, and postoperative complications of surgically treated pediatric forearm fractures over > 15-year period of American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination candidates. Methods: ABOS Part II candidates' Oral Examination Case List data from 2003 to 2019 was queried for all pediatric and adolescent (19 y of age and below) forearm fractures treated operatively. Patient demographics, fracture type, complications, and candidate fellowship type were identified for each case. Linear regression was used to delineate annual trends in patient age, complication rates, and case volume by fellowship type. Analysis of variance was performed to evaluate complication rates by fellowship type. Statistical significance for all comparative analyses was set at P-value < 0.05. Results: A total of 4178 pediatric and adolescent forearm fractures (mean age: 12.6 y; SD: 3.7 y) were treated surgically among ABOS Part II Oral Examination candidates during their 6-month collection periods from 2003 to 2019. The mean patient age decreased significantly (P < 0.001) over the study timeframe, while complication rates increased (P < 0.001). Pediatric fellowshiptrained orthopaedic surgeons performed significantly more cases than general orthopaedic surgeons over recent years (P < 0.001). No significant trends were identified between fellowship type and complication rates. The overall surgical complication rate was From the

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Preinjury Frailty Predicts 1-Year Mortality in Older Adults With Traumatic Spine Fractures

Fields,

Varga,

Alattar

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Nearly 30% of older adults presenting with isolated spine fractures will die within 1 year. Attempts to ameliorate this alarming statistic are hindered by our inability to identify relevant risk factors. The primary objective of this study was to develop a prediction model that identifies feasible targets to limit 1-year mortality. METHODS: This retrospective cohort study included 703 older adults (65 years or older) admitted to a level I trauma center with isolated spine fractures, without neural deficit, from January 2013 to January 2018. Multivariable analysis was used to select for independently significant patient demographics, frailty variables, injury metrics, and management decisions to incorporate into distinct logistic regression models predicting 1-year mortality. Variables were considered significant, if P < .05. RESULTS: Of the 703 older adults, 199 (28.3%) died after hospital discharge, but within 1 year of index trauma. Risk Analysis Index (RAI; odds ratio [OR]: 1.116; 95% CI: 1.087-1.149; P < .001) and ambulation requiring a cane (OR: 2.601; 95% CI: 1.151-5.799; P = .02) or walker (OR: 4.942; 95% CI: 2.698-9.196; P < .001), ie, frailty variables, were associated with increased odds of 1-year mortality. Spine trauma scales were not associated with 1-year mortality. Longer hospital stays (OR: 1.112; 95% CI: 1.034-1.196; P = .004) and nursing home discharge (OR: 3.881; 95% CI: 2.070-7.378; P < .001) were associated with increased odds, while discharge to rehab (OR: 0.361; 95% CI: 0.155-0.799; P = .014) decreased 1-year mortality odds. A “preinjury” regression model incorporating Risk Analysis Index and ambulation status resulted in an area under receiver operating characteristic curve (AUROCC) of 0.914 (95% CI: 0.863-0.965). A “postinjury” model incorporating Glasgow Coma Scale, hospital stay duration, and discharge disposition resulted in AUROCC of 0.746 (95% CI: 0.642-0.849). Combining elements of the preinjury and postinjury models into an “integrated model” produced an AUROCC of 0.908 (95% CI: 0.852-0.965). CONCLUSION: Preinjury frailty measures are most strongly associated with 1-year mortality outcomes in older adults with isolated spine fractures. Incorporating injury metrics or management decisions did not enhance predictive accuracy. Further work is needed to understand how targeting frailty may reduce mortality.

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Transfers of pediatric patients with isolated injuries to a rural Level 1 Orthopedic Trauma Center in the United States: are they all necessary?

Cited by 3 publications

References 28 publications

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

Trends in Operative Treatment of Pediatric and Adolescent Forearm Fractures Among American Board of Orthopaedic Surgery Part II Candidates

Preinjury Frailty Predicts 1-Year Mortality in Older Adults With Traumatic Spine Fractures

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