Early Pediatric Fractures in a Universally Insured Population within the United States

Jared A Wolfe,Amanda Banaag,Tracey Perez Koehlmoos,Heather Wolfe,Scott Tintle

doi:10.1186/s12887-019-1725-y

Abstract

BackgroundMusculoskeletal injury, including fracture, is one of the most common causes of morbidity in pediatric patients. The purpose of this epidemiologic study is to determine the prevalence and risk factors for fracture in a large cohort of pediatric patients under the age of 5.ResultsOf the 233,869 patients included in the study, 13,698 fractures were identified in 10,889 patients. The highest annual incidence was in the 4 year old age group with a rate of 24.2 fractures per 1000 children. The annual incidence within all age groups was 11.7 fractures per 1000 children. The two most common fractures were forearm and humerus fractures. Fracture incidence was increased in male children, patients who live outside the US, and in Caucasian patients. An increase in rate of fracture was also identified in children of officers when compared with children of enlisted service members. There were 35 abuse related fractures in our cohort, with 19 of them occurring in children less than 1 year old. Only three children in our cohort had Osteogenesis Imperfecta.ConclusionFractures are common injuries in young children with an incidence over the first 5 years of life of 5.86%. Multiple risk factors were also identified including age, race, geographic location and socioeconomic status. The results of this study are an important contribution to epidemiologic and public health literature and serve to characterize the incidence of and risk factors for sustaining an early childhood fracture.

Highlights

Musculoskeletal injury, including fracture, is one of the most common causes of morbidity in pediatric patients
The Military Health System Data Repository (MDR) was initially queried for all infants born between 2006 and 2009, and evaluated by using the Defense Enrollment Eligibility Reporting System (DEERS) in order to ensure a minimum of 5 years of medical beneficiary eligibility
The most common fractures in all age groups were forearm fractures, which increased in annual incidence with the age of the child from .56 per 1000 children at age 1 to 8.56 per 1000 children at age 4

Summary

Introduction

Musculoskeletal injury, including fracture, is one of the most common causes of morbidity in pediatric patients. It is estimated that 1 out of 4 children will sustain an accidental injury during childhood which will require urgent medical care [1]. This accounts for roughly 9.2 million visits to the emergency room per year. In addition to the multitude of fractures presenting to the ER some children may present directly to an urgent care facility or primary care provider. Despite this large burden of disease, exact fracture incidence and characteristics including demographics and risk factors have not been well described

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Conclusion