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Pediatric Hand Conditions Presenting to U.S. Emergency Departments, 2008-2012
David L. Colen, MD1; Justin P. Fox, MD, MHS1; Ines C Lin, MD, FACS2
1University of Pennyslvania, Philadelphia, PA, 2Children's Hospital of Philadelphia, Philadelphia, PA
Introduction: Hand injuries represent one of the most common pediatric conditions presenting to Emergency Departments (ED) in the United States. The goal of this study is to describe the epidemiology of common pediatric hand conditions presenting to American EDs over a four year period while highlighting the healthcare charges incurred as a result.
Methods: Using the National Emergency Department Sample, a nationally representative sample of ED encounters, we identified all ED encounters by patients aged younger than 18 years that were associated with a hand diagnosis from 2008-2012. Patients were divided into four groups by age (<5 years, 6-9 years, 10-13 years, and 14-17 years old) and a trauma subgroup. The primary outcomes were prevalence, etiology, and associated charges (accounting for inflation) for common hand conditions. Significance in trends was tested using regression models. All analyses were weighted to account for complex sampling design and to provide national estimates.
Results: The final sample included 11.7 million ED encounters associated with a common hand condition (mean=2.3 million/year), and 89.8% had a hand diagnosis as the primary diagnosis. Fracture was the most common injury type overall (28.2%) and in each age group, except for the 14-17 year group in which it was narrowly surpassed by contusions (22.5%). (Figure 1) Dislocations were common in the youngest group (17.7%) but rare in the other three (range = 0.8%-1.6%). Trauma-related injuries comprised 73.2% of visits with the most common mechanism being falls (29.9%); 96.9% of trauma patients were discharged home from the ED. The trend in yearly ED visits showed a bi-modal peak in the spring and fall months and a nadir in the winter. (Figure 2) Overall, \.1 billion was generated in ED charges during the course of the study. Private insurance providers were the anticipated payer in 46.5% of visits overall, however in the <5 years group, Medicaid paid for 48.7% of visits. While the overall volume of visits related to pediatric hand visits decreased over the course of the study, the associated charges rose by 1.21%. (Figure 3)
Conclusion: Pediatric hand injuries place a significant burden on the economy of the US healthcare system. Types of injuries and anticipated payers vary among age groups and while total yearly visits have decreased, the average cost of visits has risen. Figures:
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