Distal radius torus kırıklarında tedavi maaliyetlerini azaltmak mümkün mü?

Amaç: Çalışmamızda çocuklarda sık görülen bir kırık tipi olan Torus kırıklarında acil serviste ebeveyn bilgilendirmesi yapılan ve yapılmayan gruplarda uygulanan radyolojik inceleme sayısı, ortopedi poliklinik başvuru sayısı, erken ortopedi poliklinik başvuru zamanı, redüksiyon uygulanmasının kırık iyileşme skorları ve tedavi maliyetine olan etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: 1 Nisan 2020- 1 Eylül 2022 tarihleri arasında açılanma göstermeyen stabil torus kırığı olan, 0-16 yaş aralığında, 85 hasta değerlendirildi. Acil serviste değerlendirilip Ortopedi polikliniğine başvurması söylenen 44 hasta ve acil serviste Ortopedist tarafından değerlendirilip ebeveynlere kırık ile ilgili bilgilendirme yapılan 41 hastanın; ortopedi polikliniğine ilk başvuru zamanı, ortopedi poliklinik başvuru sayısı, yapılan radyolojik inceleme sayısı, redüksiyon yapılıp yapılmaması gibi verilerin, kırık iyileşme skorları ve güncel tedavi maliyetleri ile ilişkisi istatistiksel olarak karşılaştırıldı. Bulgular: Acil serviste ebeveyn bilgilendirilen 41 hasta ve ebeveyni bilgilendirilmeyen 44 hastanın Modified MAYO Bilek Skoru, yaş, cinsiyet ve komplikasyon dağılımları benzerdi (sırasıyla, p=0.800, p=0.712, p=0.815, p=0.482). Acil serviste bilgilendirilen ebeveyn grubundaki hastaların ortopedi poliklinik başvuru sayıları anlamlı daha düşük (p<0.001), ilk ortopedi poliklinik başvuru zamanları anlamlı daha geç (p<0.001) ve çekilen X-Ray sayıları anlamlı daha az idi (p<0.001). Hastaların Modifiye MAYO Bilek Skorları skoru ile ortopedi poliklinik başvuru sayısı, ilk ortopedi poliklinik başvuru zamanı, redüksiyon işlemi ve çekilen X-Ray sayısı arasında korelasyon bulunamadı (p>0.05). Çalışmada fazladan istenen tetkik ve grafi gibi işlemler maliyetlerde %6-41 arasında değişen oranlarda değişikliğe neden olmuştur. Sonuç: Stabil torus kırıklarında acil servislerde ebeveynlerin yeterli bilgilendirilmesi poliklinik başvuru ve radyografi sayısının azalmasına böylelikle tedavi maliyetlerinde düşüş sağlar. Redüksiyon yapılıp yapılmaması, radyografi sıklığı, poliklinik başvuru sayısı ve zamanının el bilek MAYO skorlarına etkisi yoktur.

Anahtar Kelimeler:

Distal Radius, Torus kırığı, Ebeveyn Bilgilendirme, Poliklinik Başvuru Sıklığı, Radyografi Sıklığı, Tedavi Maaliyeti, Distal radius, torus fracture, parents information, polyclinic application frequency, radiography frequency, treatment cost

Is it possible to reduce treatment costs in distal radius torus fractures?

Aim: The aim of the study was to evaluate the effect of parental information on the number of radiological examinations, the number of orthopedics outpatient visits, the duration of early orthopedic outpatient admission, the fracture recovery scores of reduction, and the cost of treatment of torus fractures in children in in the emergency service.Material and Method: A total of 85 patients having stable torus fractures, aged between 0-16 years have been included to the longituidinal study during the period of first of April 1, 2020 and first of September, 2022. A total of 44 patients whose parents are not informed were evaluated in the emergency department and were transfered to the Orthopedics polyclinic (No Information group- No-INF), whereas 41 patients were evaluated by the Orthopedist in the emergency department and their parents were informed directly (Information group- INF). The groupd were compared in terms of the duration of the first admission to the orthopedic polyclinic, the number of applications to the orthopedic polyclinic, the number of radiological examinations performed, whether reduction has been performed, fracture healing scores and current treatment costs and correlation was analyzed. Results: The MAYO Wrist Score (p=0.80), age (p=0.712), gender (p=0.815), and complications (p=0.482) did not differ significantly between the No-INF and INF groups. Patients in the INF group whose parents have been directly informed in the emergency department had lower orthopedic polyclinic application rates (p<0.001), longer delay for the first orthopedic polyclinic admission (p<0.001) and a lower probability and/or less number of X-Ray evaluation(p<0.001). Correlation between the variables such as Patient’s Modified MAYO Wrist Scores, the number of orthopedic polyclinic visits, the first orthopedic polyclinic admission time, the reduction procedure and the number of X-Rays was not ststistically significant (p>0.05). Findings show that additional tests and procedures such as radiography has increased the costs of 6-41% in the present study. Conclusion: It can be concluded that adequate information in the emergency services for parents of children with stable torus fractures might provide a reduction in treatment costs due to lower orthopaedic polyclinic admission and reduced radiographic examination. Wrist MAYO scores have not been affected application of reduction, radiographic evaluation, polyclinic admission and time.

Keywords:

Distal radius, torus fracture, parents information, polyclinic application frequency, radiography frequency, treatment cost,

PDF

___

Naranje S, Erali R, Warner W, Sawyer J, Kelly D. Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop 2016; 36: 45-8.
Kitabjian A, Ladores S. Treatment and management of torus fractures in pediatric patients. JNP 2020; 16: 48-56.
Hill C, Masters J, Perry D. A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist. J Pediatr Orthoped 2016; 25: 183-90
Neal E. Comparison of splinting and casting in the management of torus fracture. Emerg Nurse 2014; 21: 22-4.
Koelink E, Schuh S, Howard A, Stimec J, Barra L, Boutis K. Primary care physician follow-up of distal radius buckle fractures. Pediatrics 2016; 137: e20152262.
Alsawadi A, Abbas M. Comparison of splint and conventional cast for treating wrist torus fractures in children (systematic review). Adv J Emerg Med 2017; 6: 1-15.
Jiang N, Cao ZH, Ma YF, Lin Z, Yu B. Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis. Pediatr Emerg Care 2016; 32: 773-8.
Riera-Álvarez L, Pons-Villanueva J. Do wrist buckle fractures in children need follow-up? Buckle fractures’ follow-up. J Pediatr Orthop B 2019; 28: 553-4.
Ling SJ, Cleary AJ. Are Unnecessary Serial Radiographs Being Ordered in Children with Distal Radius Buckle Fractures? Radiol Res Pract 2018; 2018: 5143639.
Perry DC, Achten J, Knight R, et al. Do torus fractures of the wrist in children require immobilisation? A randomised controlled equivalence trial. Lancet 2022; 400: 39-47.
Colaco K, Willan A, Stimec J, et al. Home management versus primary care physician follow-up of patients with distal radius buckle fractures: a randomized controlled trial. Ann Emerg Med 2021; 77: 163–73
Boutis K, Narayanan U. Torus fractures of the distal radius: time to focus on symptomatic management. Lancet 2022; 400: 4-5.
Sacristán JA, Aguarón A, Avendaño-Solá C, et al. Patient involvement in clinical research: why, when, and how. Patient Prefer Adherence 2016; 10: 631-40.
Boutis K, Howard A, Constantine E, Cuomo A, Somji Z, Narayanan UG. Evidence into practice: pediatric orthopaedic surgeon use of removable splints for common pediatric fractures. J Pediatr Orthop 2015; 35: 18-23
Wallace A, Cain T. “Radiation risk of medical imaging for adults and children,” Available from: https://www.insideradiology.com.au/ radiation-risk-hp/. Available date: 28.9.2022
Health Care Payment Learning & Action Network. Alternative Payment Model (APM) Framework White Paper Refreshed 2017. Available from: https://hcp-lan.org/groups/apm-refresh-white-paper/. Available date: 1.10.2022
Godfrey JM, Little KJ, Cornwall R, Sitzman TJ. A bundled payment model for pediatric distal radius fractures: defining an episode of care. J Pediatr Orthop 2019; 39: e216.
Kılıç M, Koçak M. Evaluation of violence against emergency physicians. J Health Sci Med 2022; 5: 1698-703.
Kamu Sağlık Hizmetleri Fiyat Tarifesi 8.09.2022.zip Available from: https://khgmfinansalanalizdb.saglik.gov.tr/TR-40231/fiyat-tarifeleri.html. Available date: 1.10.2022
Holm AGV, Lurås H, Randsborg PH. The economic burden of outpatient appointments following paediatric fractures. Injury 2016; 47: 1410-3.
Woo CY, Wong PLK, Mahadev A. The single visit treatment of pediatric distal radius buckle fractures–A center’s experience with the treatment algorithm. Injury 2020; 51: 2186-91.
Little KJ, Godfrey J, Cornwall R, Carr P, Dolan K, Balch Samora J. Increasing brace treatment for pediatric distal radius buckle fractures: using quality improvement methodology to implement evidence-based medicine. J Pediatr Orthop 2019; 39: 586-91.
Fitzgerald E, Mannion J, Boran S. Management of “torus” or “buckle” fractures of the distal radius: a systematic review. Ir J Med Sci 2022; 19: 2311-8.