Dataset Information

Pediatric Hand Fracture Referring Practices: A Scoping Review.

ABSTRACT: Background:Pediatric hand fractures are common, but few require surgery; therefore, these fractures are often perceived to be overreferred. Our objective is to systematically identify and describe pediatric hand fracture referring practices. Method:A scoping review was performed, searching electronic databases and grey literature up to January 2018 to identify referring practices for children (17 years and younger) with hand fractures (defined as radiographically confirmed fractures distal to the carpus) to hand surgeons. All study designs were included, and study selection and data extraction were independently performed in duplicate by 2 reviewers. Outcomes included referring rates, necessity of referral, referring criteria, and management of fractures. Results:Twenty (10 cross-sectional, 7 prospective cohorts, and 3 narrative reviews) studies reporting on referring practices or management of 21,624 pediatric hand fractures were included. Proportion of pediatric hand fractures referred to hand surgeons ranged from 6.5% to 100%. Unnecessary referral, defined as those fractures within the scope of primary care management, ranged from 27% to 78.1%. Ten studies reported referring criteria, with 14 unique criteria identified. The most common referring criteria were displacement (36.4%), loss of joint congruity (36.4%), and instability (36.4%). The most common justification for these criteria was increased likelihood of requiring surgery. The most common initial management was immobilization (66%-100%). Final management was provided by orthopedic or plastic hand surgeons with 0% to 32.9% of fractures requiring surgery. Conclusion:Referring practices vary widely in the literature. Major gaps in the literature include objective measures and justification for referring criteria and primary care education on hand fracture referring practices.

SUBMITTER: Hartley RL

PROVIDER: S-EPMC6851727 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Pediatric Hand Fracture Referring Practices: A Scoping Review.

Hartley Rebecca L RL Todd Anna R AR Harrop Alan R AR Fraulin Frankie O G FOG

Plastic surgery (Oakville, Ont.) 20190924 4

<h4>Background</h4>Pediatric hand fractures are common, but few require surgery; therefore, these fractures are often perceived to be overreferred. Our objective is to systematically identify and describe pediatric hand fracture referring practices.<h4>Method</h4>A scoping review was performed, searching electronic databases and grey literature up to January 2018 to identify referring practices for children (17 years and younger) with hand fractures (defined as radiographically confirmed fractur ...[more]

PMID: 31763335

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Project description:ObjectiveCommunication during consultations between referring and consultant physicians is often cited as a source of adverse events, medical error and professional incivility. While existing literature focuses on the role of referring physicians, few studies acknowledge the role of consultant physicians in enhancing communication during consultations. This scoping review aims to identify and synthesise available recommendations to enhance the communication practices of consultants during real-time consultations.DesignA scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.Data sourcesMedline, EMBASE and PsycINFO databases were searched from inception to August 2022.Eligibility criteria for selecting studiesEnglish-language publications which describe recommendations, strategies or frameworks to improve the communication practices of consultant physicians during real-time consultations with referring physicians.Data extraction and synthesisThe search strategy included the following concepts: consultation, physician, communication, interprofessional relations and best practice. Two authors independently performed each phase of title and abstract screening, full-text review and data extraction. Discrepancies were resolved by a third author. Extracted data were iteratively analysed and summarised thematically.ResultsSixteen publications met the inclusion criteria. Synthesis of available recommendations identified organisation, expertise and interpersonal skills as three overarching and interconnected dimensions of communication demonstrated by consultants during effective consultations. Twelve studies identified interpersonal skills as being critical in alleviating the widespread professional incivility that is reported during consultations. Existing recommendations to improve the communication practices of consultants are limited as they lack standardised interventions and fail to comprehensively address all three elements identified in this review.ConclusionThis scoping review synthesises available recommendations to improve the communication practices of consultant physicians during real-time consultations. An opportunity exists to develop communication tools or educational interventions based on the findings of this review to enhance interphysician consultation encounters.

Project description:BackgroundThe hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014-2016 and, using published data, also long-term time trends in 1950-2016.Patients and methodsThe Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014-2016. These data were compared to those from three published studies that evaluated periods in 1950-2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI.ResultsIn 2014-2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014-2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014-2016 was similar to 2005-2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950-2016, we found that age-adjusted incidence increased in 1950-1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979-2016, in boys by - 0.7%; 95% CI - 1.4 to - 0.003, and girls by - 1.3%; 95% CI - 2.4 to - 0.1.ConclusionsPhalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950-1979 and decreased in 1979-2016.Level of evidenceIII.

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Pediatric Hand Fracture Referring Practices: A Scoping Review.

Publications

Pediatric Hand Fracture Referring Practices: A Scoping Review.

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