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American Association for Hand Surgery

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Patterns of Follow-Up Compliance in Pediatric Hand Injury Patients
Priyashma Joshi, BA, Nicholas Mirsky, BS, Grace Dima, BS, Minji Kim, BS, Hari Iyer, MD, MPH and Helen Hui-Chou, MD, FACS, University of Miami, Miami, FL

Introduction
Hand injuries are a common cause of pediatric emergency department (ED) visits.[i] Research is limited concerning follow-up appointment compliance for pediatric hand-injuries. Successful compliance could pose a unique benefit to pediatric patients due to their faster healing rates as compared to adults.[ii] The purpose of this study is to investigate compliance to hand injury follow-up care in pediatric patients through an analysis of attendance and barriers to scheduled follow-up appointments.
Methods
A retrospective chart review of pediatric hand clinic follow-up visits was conducted on patients at a major US level I trauma center. The review included data from November 2019 to November 2020. Pediatric patients under the age of 18 with upper extremity injuries distal to the elbow were included. Patients not scheduled for a follow-up were excluded. Follow-ups, defined as non-surgical appointments made after initial ED visit, were recorded for 1st visit attendance. Data was analyzed using binomial logistic regression with statistical significance set at p < 0.05.[iii]
Results
A total of 236 pediatric patients, average age 9.9 (SD = 4.68) years, were scheduled for follow-up appointments at the ED between November 2019 and November 2020. A compliance rate of 74.6% was identified as having attended their first follow-up appointment. Patients who lived a distance 20-50 miles from the hospital or whose primary injury was laceration were significantly less likely to follow-up when compared to other distance ranges and injury types, respectively. Insurance, gender, race, language preference, and mechanism of injury (MOI) were not significantly associated with follow-up compliance.
The majority of the cohort was male (67.4 %) and had government-funded insurance (69.0 %). The most common MOI's were fall from standing (33.9%), crush injury (16.7%), and contact sports (10.3%). The most common types of injuries were radial fractures (45.2%), phalanx fractures (24.1%), ulnar fractures (14.6%), lacerations (10.1%), and both-bone forearm fractures (6.0%).
Conclusion
Follow-ups for pediatric patients ensure that their care is being adequately monitored for a population that is unable to make their own health decisions. This study identified a gap in follow-up care for pediatric hand injury patients, which can be partially explained by distance to follow-up appointment and injury type. However, lack of other statistically significant demographic factors calls for a need to further explore limitations. By identifying factors that put patients at risk for non-compliance, we can attempt to implement systems that mitigate these factors and improve follow-up rates and therefore patient outcomes.


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