{"id":2426,"date":"2021-06-15T00:00:00","date_gmt":"2021-06-15T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/factors-affecting-management-of-childrens-low-risk-distal-radius-fractures-in-the-emergency-department-a-population-based-retrospective-cohort-study\/"},"modified":"2023-06-14T19:47:55","modified_gmt":"2023-06-14T23:47:55","slug":"factors-affecting-management-of-childrens-low-risk-distal-radius-fractures-in-the-emergency-department-a-population-based-retrospective-cohort-study","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/factors-affecting-management-of-childrens-low-risk-distal-radius-fractures-in-the-emergency-department-a-population-based-retrospective-cohort-study\/","title":{"rendered":"Factors affecting management of children&rsquo;s low-risk distal radius fractures in the emergency department: a population-based retrospective cohort study"},"content":{"rendered":"<p><strong>Background <\/strong>&#x2014; Ten randomized controlled trials over the last 2 decades support treating low-risk pediatric distal radius fractures with removable immobilization and without physician follow-up. We aimed to determine the proportion of these fractures being treated without physician follow-up and to determine whether different hospital and physician types are treating these injuries differently.<\/p>\n<p><strong>Methods <\/strong>&#x2014; We conducted a retrospective population-based cohort study using ICES data. We included children aged 2-14 years (2-12 yr for girls and 2-14 yr for boys) with distal radius fractures having had no reduction or operation within a 6-week period, and who received treatment in Ontario emergency departments from 2003 to 2015. Proportions of patients receiving orthopedic, primary care and no follow-up were determined. Multivariable log-binomial regression was used to quantify associations between hospital and physician type and management.<\/p>\n<p><strong>Results <\/strong>&#x2014; We analyzed 70 801 fractures. A total of 20.8% (n = 14 742) fractures were treated without physician follow-up, with the proportion of physician follow-up consistent across all years of the study. Treatment in a small hospital emergency department (risk ratio [RR] 1.86, 95% confidence interval [CI] 1.72-2.01), treatment by a pediatrician (RR 1.22, 95% CI 1.11-1.34) or treatment by a subspecialty pediatric emergency medicine-trained physician (RR 1.73, 95% CI 1.56-1.92) were most likely to result in no follow-up.<\/p>\n<p><strong>Interpretation <\/strong>&#x2014; While small hospital emergency departments, pediatricians and pediatric emergency medicine specialists were most likely to manage low-risk distal radius fractures without follow-up, the majority of these fractures in Ontario were not managed according to the latest research evidence. Canadian guidelines are required to improve care of these fractures and to reduce the substantial overutilization of physician resources we observed.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; Ten randomized controlled trials over the last 2 decades support treating low-risk pediatric distal radius fractures with removable immobilization and without physician follow-up. We aimed to determine the proportion of these fractures being treated without physician follow-up and to determine whether different hospital and physician types are treating these injuries differently. Methods &#x2014; [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-2426","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Baxter T, To T, Chiu M, Camp M, Howard A. <em>CMAJ Open<\/em>. 2021; 9(2):E659-66. Epub 2021 Jun 15.","source_url":"http:\/\/cmajopen.ca\/content\/9\/2\/E659.full","ices_scientist":[1262,1111],"site":[6735],"research_program":[6746],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"F0793540-5F8D-450B-B2F9-88340F2C1725","sitecore_item_name":"Factors-affecting-management-of-childrens-low-risk-distal-radius-fractures-in-the-emergency","sitecore_field_values":"{\n  \"Title\": \"Factors affecting management of children's low-risk distal radius fractures in the emergency department: a population-based retrospective cohort study\",\n  \"Short title\": \"Factors affecting management of\",\n  \"Summary\": \"We aimed to determine the proportion of fractures being treated without physician follow-up and determine whether different hospital and physician types are treating these injuries differently.\",\n  \"Citation\": \"<p>Baxter T, To T, Chiu M, Camp M, Howard A. <em>CMAJ Open<\/em>. 2021; 9(2):E659-66. Epub 2021 Jun 15. DOI: <a href=\"https:\/\/doi.org\/10.9778\/cmajo.20200116\" title=\"opens external link\">https:\/\/doi.org\/10.9778\/cmajo.20200116<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Background <\/strong>&mdash; Ten randomized controlled trials over the last 2 decades support treating low-risk pediatric distal radius fractures with removable immobilization and without physician follow-up. We aimed to determine the proportion of these fractures being treated without physician follow-up and to determine whether different hospital and physician types are treating these injuries differently.<\/p>n<p><strong>Methods <\/strong>&mdash; We conducted a retrospective population-based cohort study using ICES data. We included children aged 2-14 years (2-12 yr for girls and 2-14 yr for boys) with distal radius fractures having had no reduction or operation within a 6-week period, and who received treatment in Ontario emergency departments from 2003 to 2015. Proportions of patients receiving orthopedic, primary care and no follow-up were determined. Multivariable log-binomial regression was used to quantify associations between hospital and physician type and management.<\/p>n<p><strong>Results <\/strong>&mdash; We analyzed 70 801 fractures. A total of 20.8% (n = 14 742) fractures were treated without physician follow-up, with the proportion of physician follow-up consistent across all years of the study. Treatment in a small hospital emergency department (risk ratio [RR] 1.86, 95% confidence interval [CI] 1.72-2.01), treatment by a pediatrician (RR 1.22, 95% CI 1.11-1.34) or treatment by a subspecialty pediatric emergency medicine-trained physician (RR 1.73, 95% CI 1.56-1.92) were most likely to result in no follow-up.<\/p>n<p><strong>Interpretation <\/strong>&mdash; While small hospital emergency departments, pediatricians and pediatric emergency medicine specialists were most likely to manage low-risk distal radius fractures without follow-up, the majority of these fractures in Ontario were not managed according to the latest research evidence. Canadian guidelines are required to improve care of these fractures and to reduce the substantial overutilization of physician resources we observed.<\/p>n<p><a href=\"http:\/\/cmajopen.ca\/content\/9\/2\/E659.full\" title=\"opens external link\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}\",\n  \"ICES Locations\": \"{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}\",\n  \"ICES Scientists\": \"{EB0BB61E-C979-40CD-9508-BD1EAF5F6864}|{D71521CC-C03D-4F97-985F-4AFF626B22B9}|{198CB764-0CEA-499E-A508-1CAAAD283C90}\",\n  \"Posted Date\": \"20210615T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2021\/June\/Factors-affecting-management-of-childrens-low-risk-distal-radius-fractures-in-the-emergency"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Factors affecting management of children&#039;s low-risk distal radius fractures in the emergency department: a population-based retrospective cohort study<\/title>\n<meta name=\"description\" content=\"Background &#x2014; 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