Return to Daycare Following Fracture Immobilization in Preschool-Aged Children

Location

Medical Education Building, LSUHSC-NO

Presentation Date

10-10-2019 10:00 AM

End Date

10-10-2019 12:00 PM

Description

Introduction: Spica casting remains the gold standard for pediatric femur fractures in preschool-aged children. Several recent studies have demonstrated superior outcomes but increased cost for femur fractures treated with flexible intramedullary nails in this age group. Given the variability in treatment, additional factors such as burden of care on the patient’s family are important to further guide shared decision making. The purpose of this study was to assess the ability of children to return to daycare following varying types of casting procedures. We hypothesized that the daycare acceptance rate of patients with spica casts would be lower when compared to other fracture treatment. Methods: After IRB approval, we conducted a 40-question survey of daycare facilities that serviced a total of 6500 children from ages <1 to 4 years old within 10 miles of the New Orleans city center. Facilities were randomly selected from the comprehensive listing on the Louisiana Department of Education’s database. A power analysis was conducted, and it was established that a simple random sample of 73 facilities was necessary to estimate a 50% prevalence within ± 10% margin of error. Prevalence and confidence intervals were estimated using a finite population correction (n = 282). Results: Overall, 282 facilities met inclusion criteria and 85 were randomly selected to be interviewed to allow for a 15 % non-response rate. A total of 73 childcare facilities agreed to participate in the study. Childcare facilities median (min – max) number of children was 40 (6 – 1,250) and number of personnel was 8 (1 - 200). The percent acceptance rate (95% CL) for upper extremity casts was 91.8% (86.2 - 97.3%) while lower extremity casts regardless of weight bearing status were only accepted at 61.1% (51.2 -71.0%) of the daycares. Spica casts were divided into single leg, one and a half leg, and two leg, which were accepted at 22.5% (14.0 - 31.1%), 18.1% (10.2 - 25.9%), and 15.7% (8.2 - 23.2%) of the daycares, respectively. Surgically repaired femur fractures (postoperative surgical dressing only) had an acceptance rate of 69.4% (60.1 - 78.8 %). Spica casts were accepted only by childcare facilities who also accepted lower extremity casts. Discussion: The study shows that spica casts were not as readily allowed to return to childcare facilities when compared to surgically treated femur fractures. Additionally, lower leg casting had decreased acceptance rates compared to upper extremity casts. The majority of daycare facilities survey would not allow children with spica casts to return until cast removal. This may place a large burden on single parent families and families with two working parents. Surgeons should be aware of the potential burden placed on families by certain types of immobilization.

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Mentor: Michael Heffernan MD

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Oct 10th, 10:00 AM Oct 10th, 12:00 PM

Return to Daycare Following Fracture Immobilization in Preschool-Aged Children

Medical Education Building, LSUHSC-NO

Introduction: Spica casting remains the gold standard for pediatric femur fractures in preschool-aged children. Several recent studies have demonstrated superior outcomes but increased cost for femur fractures treated with flexible intramedullary nails in this age group. Given the variability in treatment, additional factors such as burden of care on the patient’s family are important to further guide shared decision making. The purpose of this study was to assess the ability of children to return to daycare following varying types of casting procedures. We hypothesized that the daycare acceptance rate of patients with spica casts would be lower when compared to other fracture treatment. Methods: After IRB approval, we conducted a 40-question survey of daycare facilities that serviced a total of 6500 children from ages <1 to 4 years old within 10 miles of the New Orleans city center. Facilities were randomly selected from the comprehensive listing on the Louisiana Department of>Education’s database. A power analysis was conducted, and it was established that a simple random sample of 73 facilities was necessary to estimate a 50% prevalence within ± 10% margin of error. Prevalence and confidence intervals were estimated using a finite population correction (n = 282). Results: Overall, 282 facilities met inclusion criteria and 85 were randomly selected to be interviewed to allow for a 15 % non-response rate. A total of 73 childcare facilities agreed to participate in the study. Childcare facilities median (min – max) number of children was 40 (6 – 1,250) and number of personnel was 8 (1 - 200). The percent acceptance rate (95% CL) for upper extremity casts was 91.8% (86.2 - 97.3%) while lower extremity casts regardless of weight bearing status were only accepted at 61.1% (51.2 -71.0%) of the daycares. Spica casts were divided into single leg, one and a half leg, and two leg, which were accepted at 22.5% (14.0 - 31.1%), 18.1% (10.2 - 25.9%), and 15.7% (8.2 - 23.2%) of the daycares, respectively. Surgically repaired femur fractures (postoperative surgical dressing only) had an acceptance rate of 69.4% (60.1 - 78.8 %). Spica casts were accepted only by childcare facilities who also accepted lower extremity casts. Discussion: The study shows that spica casts were not as readily allowed to return to childcare facilities when compared to surgically treated femur fractures. Additionally, lower leg casting had decreased acceptance rates compared to upper extremity casts. The majority of daycare facilities survey would not allow children with spica casts to return until cast removal. This may place a large burden on single parent families and families with two working parents. Surgeons should be aware of the potential burden placed on families by certain types of immobilization.