O2102: Insurance Status and Outcomes of Patients with Pediatric Supracondylar Humerus Fractures

Background: In treating pediatric supracondylar humerus (SCH) fractures previous studies have demonstrated no difference in clinical complications, malreduction, or postoperative loss of reduction between treatment by pediatric orthopaedic surgeons and non-pediatric orthopaedic surgeons. Despite these findings, outside institutions continue to transfer SCH fractures to pediatric institutions. The purpose of this study is to determine if insurance status, time of day, and day of the week affects transfers to a pediatric tertiary institution.

Methods: A single center, retrospective review of patients transferred to a pediatric tertiary care institution with SCH fractures between July 2017 to March 2020 was conducted. Patient age, sex, insurance status, day of the week, and time of the day were recorded. Insurance type was classified as public or private. Insurance status was compared using Fisher’s exact test.

Results: Two hundred and twenty-three patients had complete data to analyze. Average age at initial presentation was 5.2 years old (SD 2.4, range 0.8-12.0 years) with majority patients being male 55% (122/223). 4% (9/223) of patients presented with a type I fracture, 22% (50/223) with a type II fracture, 57% (127/223) with a type III fracture, and 17% (37/223) with a type IV fracture. Patients were treated with closed reduction percutaneous pinning (CRPP) (199/223), casting (9/223), or open reduction and internal fixation/ percutaneous pinning (ORIF)(ORPP) (15/223).

The time of presentation was stratified into day (7:00am-6:59pm) and night (6:59pm-7am) based on the time of patient’s arrival. 45% (70/157) of the patients presented during the day, and 55% (87/157) presented at night. The day of presentation was grouped into weekday or weekend with 69% (120/174) presenting during a weekday and 31% (54/174) presenting during the weekend. 32% (53/164) of patients presented during the daytime on a weekday and 68% (111/164) presented at night or the weekend. Although not statistically significant, those with private insurance tended to have worse fractures (Table 1) (p=0.12). No significant difference in time of presentation based on insurance type was found, however, both insurance groups demonstrated more patient transferred during “off hours” (nights/weekends) (Table 1) (p=0.85).

Conclusion: Although more patients with public insurance were transferred, there was no significant difference in the time of presentation based on insurance type. More patients were transferred at night or on the weekends, though this trend was not related to insurance status. Similar to earlier studies, insurance status is not a determining factor for the transfer of a patient. The day and time are also not reasons for transfer based on this study, suggesting that patients are being transferred for specialized higher level of care.