Differences in Treatment of Supracondylar Humerus Fractures Requiring Transfer Between Facilities

Abstract

Purpose: The current study aims to elucidate the differences in the timing of the management of operative supracondylar humerus fractures (SCHF) based on whether or not the patient is transferred between facilities. Methods: This was a prospective cohort study of patients with surgically treated SCHF conducted at a level I pediatric trauma center. The management of these fractures was compared based on their presenting facility (pediatric trauma center versus another facility). Primary outcomes were time to orthopaedic consult, time to surgery, need for open reduction, and operative times. Secondary outcomes include the need for repeat imaging, transfer time, transfer vehicle, and transfer distance. Results: A total of 146 (78 female) patients with an average age of 5.70 (±2.12) years were included in the study. Time from initial presentation to orthopaedic consult (P ​< ​0.001) and time from initial presentation to surgery (P ​= ​0.006) was shorter for Children's hospital patients compared to outside facility patients. Repeat radiographs were more common when patients presented to outside facilities compared to children's hospital (P ​< ​0.001). Operative times were the same for both groups (31 ​min children's hospital, 32 ​min outside facility). Patients arriving from the outside facility via ambulance traveled further in comparison to those arriving via private vehicle (P ​= ​0.009) but had a shorter time to operation (P ​= ​0.002). Conclusions: Efficient processes and collaboration between healthcare facilities to ensure timely and effective care for pediatric patients with SCHF are essential. Patients from outside facilities experienced longer times to orthopaedic consult and surgery while having similar baseline characteristics. Key Concepts: (1) Patients arriving from outside facilities had an overall longer time to orthopaedic consult and definitive fixation. (2) There was no difference in the need for open reduction or the operative time based on the patient's presenting facility. (3) Transferred patients often underwent repeat imaging prior to consult. Level of Evidence: II

Keywords

• Delay
• Timing
• Transfer
• Supracondylar humerus fracture