Abstract
IntroductionDistal forearm fractures (DFF) account for 1.5% of emergency department (ED) visits in the United States. Clinicians frequently obtain imaging above/below the location of injury to rule out additional injuries. We sought to determine the incidence of associated proximal fractures (APF) in the setting of DFF and to evaluate the imaging practices in a nationally representative sample of EDs.MethodsWe queried the 2013 National Emergency Department Sample using International Classification of Diseases, 9th edition, diagnostic codes for DFF and APF. Current Procedural Technology codes identified associated imaging studies. We calculated national estimates using a weighted analysis of patient and hospital-level characteristics associated with APF and imaging practices. An analysis of costs estimated the financial impact of additional imaging in patients with DFF using Medicare reimbursement to approximate costs according to the 2018 Medicare Physician Fee Schedule.ResultsIn 2013, an estimated 297,755 ED visits (weighted) were associated with a DFF, of which 1.6% (4836 cases) had an APF. The incidence of APF was lower among females (odds ratio [OR] (0.76); 95% confidence interval [CI], 0.64–0.91) but higher in metropolitan teaching hospitals compared to metropolitan non-teaching hospitals (OR [2.39]; 95% CI, 1.43–3.99) and Level 1 trauma centers (OR [3.9]; 95%, 1.91–7.96) compared to non-trauma centers. Approximately 40% (n = 117,948) of those with only DFF received non-wrist radiographs and 19% (n = 55,236) underwent non-wrist/non-forearm imaging. Factors independently associated with additional imaging included gender, payer, patient and hospital rurality, hospital region, teaching status, ownership, and trauma center level. Nearly $3.6 million (2018 U.S. dollars) was spent on the aforementioned additional imaging.ConclusionDespite the frequency of proximal imaging in patients with DFF, the incidence of APF was low. Further study to identify risk factors for APF based on mechanism and physical examination factors may result in reduced imaging and decreased avoidable healthcare spending.
Highlights
IntroductionWe sought to determine the incidence of associated proximal fractures (APF) in the setting of DFF and to evaluate the imaging practices in a nationally representative sample of EDs. Distal forearm fractures (DFF) are some of the most common fractures evaluated and treated in the United States, and this incidence has been increasing over the last 50 years.[1,2,3,4,5] DFFs account for roughly 1.5% of emergency department (ED) visits annually[3] with complications including chronic pain, osteoarthritis, median nerve compression, loss of motion, and complex regional pain syndrome.[6,7] Most injuries are due to minor trauma such as accidental falls, especially in the geriatric population.[1,3,8] With an aging population, the Medicare costs for treating these fractures are increasing
Distal forearm fractures (DFF) account for 1.5% of emergency department (ED) visits in the United States
The incidence of associated proximal fractures (APF) was lower among females (odds ratio [OR] (0.76); 95% confidence interval [CI], 0.64-0.91) but higher in metropolitan teaching hospitals compared to metropolitan non-teaching hospitals (OR [2.39]; 95% CI, 1.43-3.99) and Level 1 trauma centers (OR [3.9]; 95%, 1.91-7.96) compared to non-trauma centers
Summary
We sought to determine the incidence of associated proximal fractures (APF) in the setting of DFF and to evaluate the imaging practices in a nationally representative sample of EDs. Distal forearm fractures (DFF) are some of the most common fractures evaluated and treated in the United States, and this incidence has been increasing over the last 50 years.[1,2,3,4,5] DFFs account for roughly 1.5% of emergency department (ED) visits annually[3] with complications including chronic pain, osteoarthritis, median nerve compression, loss of motion, and complex regional pain syndrome.[6,7] Most injuries are due to minor trauma such as accidental falls, especially in the geriatric population.[1,3,8] With an aging population, the Medicare costs for treating these fractures are increasing. In 2007, $170 million (United States dollars) in payments were made by Medicare for distal radius fractures alone.[9] Many clinicians have been taught that elbow imaging should be a component of the evaluation of DFF to avoid missing corresponding injuries; there is a lack of primary literature to support this practice.[10]
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