Risk Factors for Loss to Follow-Up in Pediatric Supracondylar Humerus Fractures

Abstract

BackgroundThis study seeks to analyze risk factors associated with loss to follow-up (LTF) after pin pull in pediatric patients with operatively treated supracondylar humerus fractures (SCHF). MethodsA retrospective cohort study of patients under 18 years with operative SCHF from 2010-2020 was conducted. Factors of interest included LTF, age, race, language, distance to the hospital, Gartland fracture type, and Social Deprivation Index (SDI) by ZIP code. Univariate logistic regression was performed for each independent variable and significant variables were additionally analyzed with multivariate logistic regression analysis (MVLR). Results698 patients were included in the study. LTF was 27.8% (194/698). There was a significant difference in LTF between White and non-White (21.5% vs. 31.8%, p=0.003) patients. LTF patients had higher mean Social Deprivation Index (SDI) scores by ZIP code (59.8 vs. 45.7, p<0.0001). When comparing the most deprived to the least deprived quartile, the Odds Ratio for LTF was 3.34 (95% CI 2.12-5.27). The patients lost to follow up were also younger (mean age of 6.9 years old versus 7.8 years old; p=0.0004). After MVLR, higher SDI and younger age remained significant. ConclusionHigher social deprivation scores and younger age were associated with LTF in surgically treated pediatric SCHFs at this institution. Level of Evidencelevel III Key Concepts(1)Patients with higher Social Deprivation Index scores by zip code and younger age have higher rates of loss to follow-up after pin pull for operatively managed supracondylar humerus fractures(2)Patients that were lost to follow-up had lower rates of physical therapy prescriptions compared to patients that were not lost to follow-up(3)No differences in complications were seen in the loss to follow-up group compared to the group that follow-up