Dataset Information

Trends in Pediatric Traumatic Upper Extremity Amputations.

ABSTRACT: Background: Traumatic upper extremity amputation in a child can be a life-altering injury, yet little is known about the epidemiology or health care costs of these injuries. In this study, using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), we assess these trends to learn about the risk factors and health care costs of these injuries. Methods: Using the HCUP KID from 1997 to 2012, patients aged 20 years old or younger with upper extremity traumatic amputations were identified. National estimates of incidence, demographics, costs, hospital factors, patient factors, and mechanisms of injury were assessed. Results: Between 1997 and 2012, 6130 cases of traumatic upper extremity amputation occurred in children. This resulted in a $166 million cost to the health care system. Males are 3.4 times more likely to be affected by amputation than females. The most common age group to suffer amputation is in older children, aged 15 to 19 years old. The frequency of amputation has declined 41% from 1997 to 2012. The overwhelming majority of amputations (92.54%) involved digits. Conclusions: Pediatric traumatic amputations of the upper extremity are a significant contribution to health care spending. Interventions and educational campaigns can be targeted based on national trends to prevent these costly injuries.

SUBMITTER: Vakhshori V

PROVIDER: S-EPMC6900692 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Trends in Pediatric Traumatic Upper Extremity Amputations.

Vakhshori Venus V Bouz Gabriel J GJ Mayfield Cory K CK Alluri Ram K RK Stevanovic Milan M Ghiassi Alidad A

Hand (New York, N.Y.) 20180530 6

<b>Background:</b> Traumatic upper extremity amputation in a child can be a life-altering injury, yet little is known about the epidemiology or health care costs of these injuries. In this study, using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), we assess these trends to learn about the risk factors and health care costs of these injuries. <b>Methods:</b> Using the HCUP KID from 1997 to 2012, patients aged 20 years old or younger with upper extremity trauma ...[more]

PMID: 29845883

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Project description:ImportanceAffordable, quantitative methods to screen children for developmental delays are needed. Motor milestones can be an indicator of developmental delay and may be used to track developmental progress. Accelerometry offers a way to gather real-world information about pediatric motor behavior.ObjectiveTo develop a referent cohort of pediatric accelerometry from bilateral upper extremities (UEs) and determine whether movement can accurately distinguish those with and without motor deficits.Design, setting, and participantsChildren aged 0 to 17 years participated in a prospective cohort from December 8, 2014, to December 29, 2017. Children were recruited from Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, and Washington University School of Medicine in St Louis, St Louis, Missouri. Typically developing children were included as a referent cohort if they had no history of motor or neurological deficit; consecutive sampling and matching ensured equal representation of sex and age. Children with diagnosed asymmetric motor deficits were included in the motor impaired cohort.ExposuresBilateral UE motor activity was measured using wrist-worn accelerometers for a total of 100 hours in 25-hour increments.Main outcomes and measuresTo characterize bilateral UE motor activity in a referent cohort for the purpose of detecting irregularities in the future, total activity and the use ratio between UEs were used to describe typically developing children. Asymmetric impairment was classified using the mono-arm use index (MAUI) and bilateral-arm use index (BAUI) to quantify the acceleration of unilateral movements.ResultsA total of 216 children enrolled, and 185 children were included in analysis. Of these, 156 were typically developing, with mean (SD) age 9.1 (5.1) years and 81 boys (52.0%). There were 29 children in the motor impaired cohort, with mean (SD) age 7.4 (4.4) years and 16 boys (55.2%). The combined MAUI and BAUI (mean [SD], 0.86 [0.005] and use ratio (mean [SD], 0.90 [0.008]) had similar F1 values. The area under the curve was also similar between the combined MAUI and BAUI (mean [SD], 0.98 [0.004]) and the use ratio (mean [SD], 0.98 [0.004]).Conclusions and relevanceBilateral UE movement as measured with accelerometry may provide a meaningful metric of real-world motor behavior across childhood. Screening in early childhood remains a challenge; MAUI may provide an effective method for clinicians to measure and visualize real-world motor behavior in children at risk for asymmetrical deficits.

Project description:PurposeEmpiric antibiotic therapy for hand and upper-extremity infections aims to cover the most common causative organisms, which may change over time. The purpose of this study was to investigate the changes in the bacterial profile of upper-extremity infections over 2 decades at our institution.MethodsWe performed a retrospective chart review of patients with upper-extremity infections treated at a single level 1 trauma center between 2001 and 2019. Patients older than 18 years who underwent surgical treatment for infection with operative cultures available were included. Patient demographics, comorbidities, and culture results were reviewed. Then, the distribution of organisms was analyzed for overall prevalence, and the profile of 2001-2010 was compared with that of 2010-2019 using a chi-square test.ResultsA total of 237 patients (mean age, 43 years) met the criteria and were included in the study. Over the entire study period, the most isolated organism was Staphylococcus aureus, specifically the methicillin-resistant species. Methicillin-resistant S aureus remained the most common organism in both decades but declined over time from 47% in 2001-2010 to 27% in 2010-2019 (P < .05). There was a significant increase in the proportion of Streptococcus infections (from 6% to 17%; P < .05) and in polymicrobial infections (aerobic 8% to 28%, anaerobic 0% to 14%; P < .05). Enterobacter species were not isolated in 2001-2010 but comprised 13% of infections in the second decade (P < .05).ConclusionsMethicillin-resistant S aureus remains the most common organism isolated from upper-extremity infections, though there has been a decline over the last 20 years. Conversely, Streptococcal spp., Enterobacter spp. and polymicrobial infections have increased. This study demonstrates longitudinal shifts in the distribution of bacteria responsible for upper-extremity infections at our institution, and these trends can be considered when choosing future empiric therapy.Type of study/level of evidencePrognostic IV.

Project description:IntroductionDuring the emergence of the SARS-CoV-2 (COVID-19) pandemic, there were substantial changes in United States (U.S.) emergency department (ED) volumes and acuity of patient presentation compared to more recent years. Thus, the purpose of this study was to characterize the incidence of specific upper extremity (UE) injuries presenting to U.S. EDs during the COVID-19 pandemic and analyze trends across age groups and rates of hospital admission compared to years prior.MethodsThe National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to U.S. EDs for an UE orthopaedic injury between 2016 and 2020. Chi-square analysis and logistic regression were used to assess for differences in ED presentation volume and hospital admissions between pre-pandemic (2016 through 2019) and during-pandemic (2020) times.ResultsThese queries returned 285,583 cases, representing a total estimate of 10,452,166 injuries presenting to EDs across the U.S. The mean incidence of UE orthopaedic injuries was 640.2 (95% CI, 638.2-642.3) injuries per 100,000 person-years, with the greatest year to year decrease in incidence occurring between 2019 and 2020 (20.1%). The largest number of estimated admissions occurred in 2020, with a total 135,018 admissions (95% CI, 131,518-138,517), a 41.6% increase from the average number of admissions between 2016 and 2019.ConclusionThere was a 20.1% decrease in the incidence of UE orthopaedic injuries presenting to EDs after the start of the COVID-19 pandemic with a concomitant 41.2% increase in the number of hospital admissions from the ED in 2020 compared to recent pre-pandemic years. We speculate that at least some elective, semi-elective or urgent ambulatory surgeries were canceled or delayed due to the pandemic and were subsequently directed to the ED for admission. Regardless of the cause of increased UE orthopaedic admissions, policy planners and administrators should be aware of the additional stresses placed on already burdened ED and inpatient services.Level of evidenceLevel III - Retrospective Cohort Study.

Project description:The numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important.This retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. The revascularisation treatments were categorised in multilevel, aortoiliac, femoral to popliteal and popliteal to foot levels and sorted as open, endovascular and hybrid. The sessions in amputations were divided in major (thigh and below knee) and minor (ankle, foot or digit). Incidence rates were assessed per 100 000 for patients in the age group >60 years. The diabetic prevalence was calculated and the endovascular numbers at the South-Eastern, Western, Central and Northern Norway Regional Health Authority were compared.The overall revascularisation rates increased from 308.7 to 366.8 (p=0.02). Open revascularisations decreased from 158.9 to 98.7 (p<0.01) while endovascular revascularisations increased from 142.2 to 243.4 (p<0.01). Hybrid revascularisations increased from 7.4 to 24.8 (p<0.01). Major amputation rates decreased from 87.8 to 48.7 (p<0.01) while minor amputations increased from 12.3 to 19.6 (p=0.01). The diabetic percentages increased from 12.2 to 22.3 (p<0.01) in revascularisations, from 26.5 to 30.8 (p=0.02) in major amputations and from 43.0 to 49.3 (p=0.13) in minor. (p values refer to average annual changes.) The regional trends in endovascular treatments varied within and between the vascular groups.From 2001 to 2014, the revascularisation rates increased due to the rise in endovascular procedures. Open revascularisations and major amputation rates decreased, minor increased. The regional variances in endovascular treatments indicate that the availability of this technology differed between the health regions of Norway. The increase in patients with diabetes requires continued awareness of diabetes and its complications.

Dataset Information

Trends in Pediatric Traumatic Upper Extremity Amputations.

Publications

Trends in Pediatric Traumatic Upper Extremity Amputations.

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