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Ordinary least squares regression results of the logarithm of health-care costs on case categories, demographic and treatment characteristics.
Source publication
Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996-2003.
Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategi...
Contexts in source publication
Context 1
... estimated coefficients then show in percentage terms how much higher or lower health-care costs were associated with different characteristics, holding everything else con- stant, i.e. the marginal effects. For instance, from Table 2 column (1), children with no ward days who had utilised physiotherapy during the health-care episode cost on average 56 percent more than other children with no physiotherapy, all else equal. As both dependent variable cost and independent variable length of stay were logged in the cost equations, the coefficient was an elasticity. ...
Context 2
... than 70% of these children were admitted to the department on the same day as the injury occurred (Fig 5). A patient with a fingertip injury, treated more than 4 ward days, had a low health-care cost compared to the reference case (Table 2). ...
Context 3
... 90% were admitted to the department two or more days after they were injured, since such injuries generally were not associated with open wounds (Fig 5). Outpatients and children treated more than 4 days were associated with low health-care costs, compared to the reference case (Table 2). The children were treated in about half the number of ward days as the reference case, probably since no operation was required (Table 3). ...
Context 4
... health-care cost was substantially lower for such a case not hospitalized (Table 2), including for instance a simple wound that did not need further treatment. Among admitted patients treated less than 4 days, the cost was high compared to the reference case, which may be reflected by the tendon and nerve injuries and not wound per se (Table 2). ...
Context 5
... health-care cost was substantially lower for such a case not hospitalized (Table 2), including for instance a simple wound that did not need further treatment. Among admitted patients treated less than 4 days, the cost was high compared to the reference case, which may be reflected by the tendon and nerve injuries and not wound per se (Table 2). These cases were admitted early after the injury occurred (Fig 5), and were not associated with any significant change in length of stay (Table 3). ...
Context 6
... thirds were admitted the same day as they were injured (Fig 5). The cost analysis showed that the health- care cost was high compared to the reference case, if the patient was admitted less than 4 days ( Table 2). ...
Context 7
... children were admitted to the Department within one day after the injury (90%; Fig 5), often with an urgent transport by ambulance. In the cost analysis, the cost for such a case was substantially high compared to the reference case, among admitted patients (Table 2). These cases were not associated with any change in length of stay (Table 3). ...
Context 8
... these heterogeneous cases had low median costs but with a few outliers with high costs. The health-care cost was low compared to the reference case, if the patient was not admitted (Table 2). ...
Context 9
... surgical and physiotherapy sessions were asso- ciated with higher health-care costs, mostly so for children treated as outpatients (Table 2). For example, compared to the reference person, having one additional surgical session was associated with a 102 percent higher cost [col- umn (1)] and more ward days (Table 3). ...
Context 10
... over the whole study, 42 patients were admitted from other county councils and the first year included 16 of these. Fig 1 also illustrates the close relationship between length of stay and cost, which was consistent with our finding that ward days were the major source of cost for most patients (Table 2). We have used the price per ward day and other resource use from year 2000 paid by other county councils, which includes overhead costs. ...
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Introduction:
Distal 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 imagin...
Objective:
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Methods:
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Citations
... They are related not only to children's stress and possible impairment but are also an important economic problem. These injuries comprise about 13.0-23.0% of injury-related and 2.3% of general emergency room visits [2][3][4][5]. The hand is the second most common site of fractures (after the forearm) in most studies, but exceptions to this rule have been reported [1,6]. ...
... The socioeconomic costs of hand injuries result from multiple factors: parents' absence from work; costs of diagnosis, treatment, and hospital stays; the child's impaired working ability; and more. The annual health care costs of hand injuries in children ages 0 to 6 years from three catchment areas in south Sweden ranged from EUR 398,762 in 1996 to EUR 247,540 in 2000, and the average number of patients per year was 86 [2]. Another study from the USA reported that emergency department charges for paediatric upper limb injuries from 2008 to 2012 were USD 21.2 billion as a result of 11.7 million visits [8]. ...
... Other studies have confirmed this trend that older children tend to have more proximal fractures [3,4,7]. This emerging pattern may be explained by different mechanisms of injury at different ages; younger children usually suffer from crushing (e.g., finger closed in a door), while older children sustain trauma related to sport and fights [2,3,14,16]. ...
Background and objectives: In the paediatric population, hand injuries are one of the most frequent injuries and the second most frequent area of fracture. It is estimated that hand injuries account for up to 23% of the trauma-related causes of emergency department visits. Not only are they a significant factor in health care costs, but they may also lead to detrimental and long-term consequences for the patient. The discrepancy observed between the published studies suggests a geographical variation in their epidemiology. The aim of this study is to determine the localisation of injuries and fractures involving the hand in the paediatric population of the Polish Silesia region. This exploratory cross-sectional study involved 1441 post-traumatic hand X-ray examinations performed at the Department of Diagnostic Imaging of the John Paul II Upper Silesian Child Health Centre in Katowice between January and December 2014. Materials and Methods: The study group consisted of 656 girls and 785 boys who were 11.65 ± 3.50 and 11.51 ± 3.98 years old, respectively (range: 1–18 years). All examinations were evaluated for the location of the injury and presence of fracture(s). Results: Finger injuries were dominant (n = 1346), with the fifth finger being the most frequently injured (n = 381). The majority of injuries were observed among children who were 11 years old (n = 176), with a visible peak in the 11- to 13-year-old group. A total of 625 bone fractures were detected. Fractures of the proximal phalanges (n = 213) and middle phalanges (n = 159) were most common, and fifth finger (n = 189) predominance was again observed. A gender-independent positive correlation was found between patients’ age and finger injuries (p < 0.01) as well as metacarpal injuries (p < 0.01). There was no correlation between patients’ age and fractures in these locations (p > 0.05). Metacarpal injuries (p < 0.01), finger injuries (p < 0.01), fractures (p = 0.01), and fractures with displacement (p = 0.03) were more common among males regardless of age. Conclusions: The results indicate that 11-year-old boys are at an increased risk of hand injuries and fractures. The distal and middle phalanges of the right hand, especially of the fifth digit, were the most susceptible to fracture localisation. Thus, injuries in these areas should be perceived as most likely to cause fractures and therefore demand careful examination.
... The large number of door-related injuries may correspond to the relatively large amount of time spent indoors by children in recent years. 18) This correlates with the findings in our study where injury from doors made up 77% of all injuries. ...
... In addition, earlier studies have found that the cost of prevention of fingertip injuries by installing safety equipment was much less than the cost of treating the injuries themselves. 18) We hope that, with this data, fingertip injuries in children will be taken as a potentially serious injury, that may be easily prevented with targeted measures such as safety tools, education and awareness. Copyright of Hand Surgery is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. ...
Fingertip injuries are common in children, with varying degrees of severity. However, there is limited epidemiological information in the literature. An understanding of the characteristics of these injuries can be used as a basis to prevent such injuries. Epidemiological data was gathered through a retrospective review of all fingertip injuries affecting children, that presented to our department. There were 202 children with 234 injured fingertips in a period of 36 months. Most children were boys and most children injured their left hand. The mode age affected was 2 years. Accidental crush injuries in doors was the most common cause of fingertip injuries in children. An unexpectedly high number of children have fingertip injuries, with many requiring surgical treatment. Safety awareness and prevention of door crush injuries could reduce a large number of fingertip injuries in young children.
... Economic evaluations in orthopaedics, especially for the hand, are scarce. Examples of economic studies for the hand include the treatment of Dupuytren's disease (Chen et al., 2011;Macaulay et al., 2011;Webb and Stothard, 2009), hand and wrist injuries (de Putter et al., 2012;Ljungberg et al., 2008), and for ganglia and trigger fingers (Kerrigan and Stanwix, 2009;Webb and Stothard, 2009), with only limited information about the economic consequences due to absenteeism and presenteeism. ...
The objective of this study was to analyse healthcare and productivity costs in patients with trapeziometacarpal osteoarthritis. We included 161 patients who received surgery or steroid injection and calculated their healthcare costs in Euro (€) over 1 year. Patients filled out the Work Productivity and Activity Impairment Questionnaire to assess loss of productivity at baseline, and after 3, and 12 months. In the surgical group, loss of productivity among employed patients first increased and then decreased (50%, 64%, and 25% at 0, 3, and 12 months). Productivity was more stable over time in the injection group (52%, 38%, and 48%). In the surgical group, estimated total annual healthcare and productivity costs were €5770 and €5548, respectively. In the injection group, healthcare and productivity costs were €348 and €3503. These findings highlight the need for assessing productivity costs to get a comprehensive view of the costs associated with a treatment. Level of Evidence III.
© The Author(s) 2015.
... 2,3 Most studies that have examined door-related injuries are from countries outside of the United States and are usually limited to retrospective analysis of cases from single-hospital emergency departments (EDs). [4][5][6][7][8][9][10][11][12][13][14] Previous studies have generally included door-related injuries as part of a larger study focused on injuries to a specific body region (usually hand or finger injuries), 6,7,9,11,12,[15][16][17][18] the pinching mechanism of injury, 13,14,19,20 or the clinical management of injuries (primarily phalanx fractures). 2,3,21 Glass door-related injuries have been discussed as part of architectural glass-related injury articles but not as a separate topic. ...
This is the first study to provide national estimates of pediatric door-related injuries in the United States. Data from the National Electronic Injury Surveillance System were analyzed for patients ≤17 years who were treated in US emergency departments for a door-related injury from 1999 through 2008. An estimated 1 392 451 US children ≤17 years received emergency treatment for door-related injuries, which averages approximately 1 injury every 4 minutes in the United States. Both the frequency and rate of injury increased significantly. Boys accounted for 55.4% of injuries, and 41.6% of children were ≤4 years. The most common mechanism of injury was a “pinch in the door” (54.8%) or an “impact to the door” (42.0%). Patients admitted to the hospital were most frequently treated for amputations (32.0%) or lacerations (25.2%). The frequency of injuries associated with glass doors increased significantly with increasing age, in contrast to injuries from other types of doors.
... Given the trend to increased charges in patients who require operations, we would suspect that these patients' extrapolated charges would correlate with the current data presented. These figures are even more striking if one also takes into account the inability to capture the entire cost to the family and society with loss of productivity, travel, and other injury-associated costs, including the costs associated with outpatient care [11,12]. ...
Pediatric hand traumas are common injuries in childhood. The incidence and type of injury vary with age. In our country, there are only two publications in which only crush is examined in etiology. In this study, we aimed to develop a strategy to prevent hand injuries by examining pediatric hand injuries according to the child’s developmental stage and anatomical region. The data of 493 (315 boys, 178 girls) patients under the age of 18 between 2016 and 2020 were analyzed. Patients were categorized according to etiology and age. Males are more dominant in pediatric hand injuries (63.9%). The most common cause of hand injuries under the age of 4 years is scald burns. While distal phalanx fractures (79.7%) are more common under 7 years of age, little finger fractures (44.7%) are more common than other finger fractures over 7 years of age. The reason for the increase in fifth metacarpal (neck) fractures between the ages of 12 and 17 years is fighting and punching. Door/window jamming injuries (60.7%) are more common under the age of 7 years, while there is an increase in sports injuries (94.7%) over the age of 7 years. The findings of this study provided age-specific information about the anatomical site, objects, activities, mechanisms, diagnosis, and treatment associated with hand and finger injuries. While developing a strategy to prevent childhood hand and finger injuries in Turkey, it is necessary to focus on age.
The aim of this study was to analyse the management of nail bed injuries from a clinical and economic perspective. We carried out a retrospective analysis of nail bed injuries treated operatively at a tertiary Plastic Surgery Hand Trauma Unit during 2016. The National Schedule of Reference Costs (2015–2016) was used to estimate the costs of treating 630 patients. The most common mechanism was a crush injury in a door (33%). Fifty-five per cent of patients had an associated tuft fracture. The minimum cost per annum for patients treated for nail bed injuries in our unit was calculated to be £511,560 (€573,362; US$666,664). Many nail bed injuries are preventable and because they present a very high financial burden on the National Health Service, targeted prevention strategies should be considered.
Level of evidence: IV
Background:
The aim of this study was to analyze the epidemiology of patients admitted with finger amputations in the U.S., as well as to evaluate and propose prevention strategies.
Methods:
The National Electronic Injury Surveillance System was queried to obtain data on patients that presented to, and were admitted from US emergency departments for treatment of traumatic finger amputations during the period of 2002-2016. The Haddon Matrix, a framework that can be used to analyze the host, agent, and environmental factors of an injury relative to its timing, was then used to evaluate possible contributing factors of amputation events, and thereby explore plausible prevention interventions.
Results:
From 2002 to 2016, approximately 348,719 people were admitted from the ED for traumatic amputations. The majority were Caucasian and were male. The mean age was 42.3 years old. This was significantly older than those who were not admitted. The top five products responsible for amputations in admitted patients were power saws (40.9% of cases), doors (10.3%), lawn mowers (7.4%), snow blowers (4.3%), and bicycles (2.4%). This list included a higher proportion of powered tools than those with finger amputations who were discharged from the ED with a finger amputation.
Conclusion:
Patients admitted with finger amputations from the ED were older, more likely to be male, and more likely to be victims of powered tools than those that were discharged. Table saws are responsible for a high proportion of the finger amputations that result in hospital admissions. The Haddon Matrix helps us identify factors (host, agent, physical environment, and social environment) to be addressed in prevention strategies. Such approaches might include championing education campaigns, policy measures, and equipment safety features. The effectiveness of such strategies warrants further investigation.
Background The difficulties in surgical treatment of pilon fractures of the finger include fragment reconstitution and posthealing stiffness. In adults, external fixation with traction and early active range of motion (AROM)/passive range of motion (PROM) during healing is considered necessary for avoiding joint stiffness and attaining realignment. The authors present a unique approach to pediatric pilon fractures that uses open reduction and multivector external fixation with delayed AROM/PROM. Initial immobilization and significant traction allowed for joint realignment and prevented noncompliance with staged distraction. The authors believe this immobilization leads to a superior outcome because, unlike adults, children tend to avoid stiffness and a larger distraction force allowed for sufficient joint realignment to regain range of motion (ROM).
Methods A right-handed 13-year-old boy sustained a right ring finger fracture and presented 12 days later. Radiographs revealed a comminuted Salter-Harris 4 fracture of the middle phalanx. The patient underwent open reduction and placement of multivector external fixation using a pediatric mandibular distractor/fixator. Significant traction was applied to distract the finger to length.
Results Hardware was removed 6 weeks postoperatively and AROM was initiated after splinting. The patient started PROM 8 weeks postoperatively. Strengthening was initiated 2 weeks later. ROM improved and rehabilitation was continued. The patient exhibited nearly equal grip strength 12 weeks postoperatively. At 14 months follow-up, radiographs showed complete healing and joint realignment. There was no deformity or pain and finger length was restored.
Conclusion Management of pediatric pilon fractures is rarely described and presents unique considerations. Early-stage traction and immobilization using a multivector mandibular fixator/distractor is suitable in a child because noncompliance is avoided and there is a decreased risk for stiffness. Combining early immobilization with subsequent-staged AROM, PROM, and strengthening resulted in no loss of ROM and maintained articular symmetry.
Unlabelled:
To report the frequencies of congenital hand diseases in patients who underwent surgery on a collective mobilization basis at SOS Hand, Recife, Pernambuco, between 2005 and 2009.
Methods:
Information was collected from 833 children and adolescents who were examined in eight missions.
Results:
Among the patients, 306 (36.7%) underwent surgery: 240 (78.4%) because of congenital malformation and 66 (21.6%) because of acquired lesions. The most frequent congenital malformations were: syndactyly, 72 cases (30.0%); polydactyly, 30 cases (12.5%); bifid thumb, 19 cases (7.9%); complex hand malformation, 14 cases (5.8%); cleft hand, 13 cases (5.4%); trigger finger, 12 cases (5.0%); camptodactyly, 11 cases (4.6%); and brachysyndactyly, 9 cases (3.7%). The most frequently acquired injuries were: obstetric traumatic lesions, 26 cases (39.4%); hand trauma sequelae, 18 cases (27.3%); cerebral paralysis sequelae, 7 cases (10.6%); electric shock sequelae, 5 cases (7.6%); and burn sequelae, 4 cases (6.1%).
Conclusion:
The nosology of hand diseases is similar to that of large series of elective surgery, especially regarding congenital deformities. The frequency of acquired hand lesions seems to be higher than the frequency in international series. The collective mobilization system for hand surgery is important for decreasing the need for this activity in public institutions, and it has been shown to be very efficient. The success of the project may provide support for the Brazilian National Health System to enroll hand surgeons in the on-call system, in emergency units.
