TY - JOUR
T1 - Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures
T2 - A CORTICES Survey
AU - Children's Orthopaedic Trauma and Infection Consortium for Evidence Based Studies (CORTICES)
AU - Roper, Brennan
AU - Rose Purtell, S.
AU - De, Sayan
AU - McLaughlin, Dell
AU - Truong, Walter H.
AU - Miller, Mark L.
AU - Swarup, Ishaan
AU - Ramalingam, Wendy
AU - Sanders, Julia S.
AU - Arkader, Alexander
AU - Upasani, Vidyadhar V.
AU - Riccio, Anthony
AU - Ying Li, G.
AU - Heyworth, Benton E.
AU - Meyer, Zack
AU - May, Collin J.
AU - Spence, David D.
AU - Hill, Jaclyn F.
AU - Denning, Jaime R.
AU - Laine, Jennifer C.
AU - Larsen, Jill
AU - Schoenecker, Jonathan G.
AU - Owen, Jonas
AU - Janicki, Joseph A.
AU - Baldwin, Keith D.
AU - Stepanovich, Matt
AU - Johnson, Megan E.
AU - Goldstein, Rachel
AU - Blumberg, Todd J.
AU - Shore, Benjamin
AU - Riccio, Tony
AU - Beebe, Allan
AU - Ramo, Brandon
AU - Rosenfeld, Scott
N1 - Publisher Copyright:
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024
Y1 - 2024
N2 - Introduction: Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns. Methods: Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results. Results: Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice > 5 y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing < 10 acetabular (72.2%) but > 10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients < 10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred. Conclusions: There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common.
AB - Introduction: Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns. Methods: Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results. Results: Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice > 5 y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing < 10 acetabular (72.2%) but > 10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients < 10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred. Conclusions: There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common.
KW - acetabular fracture
KW - pediatric trauma
KW - pelvic fracture
KW - pelvic trauma
KW - practice patterns
UR - http://www.scopus.com/inward/record.url?scp=85207779576&partnerID=8YFLogxK
U2 - 10.1097/BPO.0000000000002847
DO - 10.1097/BPO.0000000000002847
M3 - Article
C2 - 39428588
AN - SCOPUS:85207779576
SN - 0271-6798
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
M1 - 10.1097/BPO.0000000000002847
ER -