Investigating the Relationship Between Neighborhood Social Deprivation and Time to Specialty Orthopedic Care for Pediatric Trigger Thumb

Abstract

PurposePediatric trigger thumb is a common condition resulting in referral from primary care to specialty care. Access to pediatric hand specialty care is a complex issue influenced by a multitude of social factors, including socioeconomic status. The aim of this study is to investigate the relationship between area deprivation and the time from primary care referral to presentation to specialty care for pediatric trigger thumb. MethodsParticipants were pediatric patients with trigger thumb. Patient-level area deprivation was reflected by the Area Deprivation Index (ADI). We analyzed the relationship of the ADI to patient demographics (age, gender), trigger thumb treatment (operative versus non-operative), and time to initial hand surgical visit after referral and surgical management when indicated. ResultsAmong 163 patients with trigger thumb, 52% were male. Mean age at referral for trigger thumb was 2.9±1.7 years. Mean ADI for patients diagnosed with trigger thumb was 57.8±23.4 for the 2018 data set and 57.3±23.6 for the 2021 data set, scale of 1 (low)–100 (high). The median time from referral from primary care to presentation to orthopedic care for trigger thumb was 34 days. Upon presentation to treating hand surgeon, 118 patients (72.4%) underwent surgical release. We found no difference in ADI between male and female patients nor between patients treated operatively or with non-operative management. We found a weak positive correlation between ADI and time from initial referral to presentation to the treating hand surgeon. There was no correlation between ADI and time from initial hand surgical evaluation and operative management in patients indicated for surgery. ConclusionsPediatric trigger thumb patients from areas with higher ADI have a slightly longer delay between initial referral and their initial visit with an orthopedic hand specialist. While we found a delay in initial evaluation by the treating hand surgeon in patients with higher ADI, ADI status was not different between patients managed with operative and non-operative treatment nor between male and female patients. Clinical RelevanceNeighborhood ADI weakly correlated with increased time from referral to accessing specialty orthopedic care for trigger thumb. This may suggest a need for more equitable access to specialty care for patients with pediatric trigger thumb from high ADI areas.