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Cook H, Zargaran D, Mosahebi A. Letter to editor regarding: 'Efficacy of virtual plastic surgery encounters in establishment of care and surgical conversion'. J Plast Reconstr Aesthet Surg 2023; 86:216-217. [PMID: 37776614 DOI: 10.1016/j.bjps.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 10/02/2023]
Affiliation(s)
- H Cook
- Department of Plastic Surgery, Royal Free Hospital, UK.
| | - D Zargaran
- Department of Plastic Surgery, Royal Free Hospital, UK; Division of Surgery and Interventional Sciences, University College London, UK
| | - A Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, UK; Division of Surgery and Interventional Sciences, University College London, UK
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Chen K, Duan GY, Wolf JM, Stepan JG. Health Disparities in Hand and Upper Extremity Surgery: A Scoping Review. J Hand Surg Am 2023; 48:1128-1138. [PMID: 37768255 DOI: 10.1016/j.jhsa.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Social determinants of health (SDOH) are linked to poor health care outcomes across the different medical specialties. We conducted a scoping review to understand the existing literature and identify further areas of research to address disparities within hand surgery. METHODS A systematic search of PubMed, Scopus, and Cochrane was conducted. Inclusion criteria were English studies examining health disparities in hand surgery. The following were assessed: the main SDOH, study design/phase/theme, and main disease/injury/procedure. A previously described health disparities research framework was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Studies were categorized according to themes outlined at the National Institute of Health and American College of Surgeons: Summit on Surgical Disparities. RESULTS The initial search yielded 446 articles, with 49 articles included in final analysis. The majority were detecting-type (31/49, 63%) or understanding-type (12/49, 24%) studies, with few reducing-type studies (6/49, 12%). Patient factors (31/49, 63%) and systemic/access factors (16/49, 33%) were the most frequently studied themes, with few investigating clinical care/quality factors (4/49, 8%), clinician factors (3/49, 6%), and postoperative/rehabilitation factors (1/49, 2%). The most commonly studied SDOH include insurance status (13/49, 27%), health literacy (10/49, 20%), and social deprivation (6/49, 12%). Carpal tunnel syndrome (9/49, 18%), upper extremity trauma (9/49, 18%), and amputations (5/49, 10%) were frequently assessed. Most investigations involved retrospective or database designs (29/49, 59%), while few were prospective, cross-sectional, or mixed-methods. CONCLUSIONS Despite an encouraging upward trend in health disparities research, existing studies are in the early phases of investigation. CLINICAL RELEVANCE Most of the literature focuses on patient factors and systemic/access factors in regard to insurance status. Further work with prospective, cross-sectional, and mixed-method studies is needed to better understand health disparities in hand surgery, which will inform future interventions.
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Affiliation(s)
- Kevin Chen
- University of Chicago, Pritzker School of Medicine, Chicago, IL.
| | - Grace Y Duan
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Jennifer M Wolf
- Department of Orthopaedic Surgery and Rehabilitation Medicine, the University of Chicago Medicine, Chicago, IL
| | - Jeffrey G Stepan
- Department of Orthopaedic Surgery and Rehabilitation Medicine, the University of Chicago Medicine, Chicago, IL
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Patient Satisfaction with Virtual Clinic Encounters: Analysis of Factors that Impact the Press Ganey Survey in the Hand Surgery Population. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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A Comprehensive Study on Epidemiology Case Studies Using Computational Analysis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6508866. [PMID: 36120678 PMCID: PMC9473870 DOI: 10.1155/2022/6508866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
Health-related issues and occurrences with regard to a particular population are the subject of an epidemiology study. This paper presents the results of a retrospective epidemiological investigation on 15922 hospitalized hand trauma patients from Central China between 2011 and 2020. Gender, age, onset season, injury mechanism, injury environment, injury location, and clinical characteristics are among the characteristics of the data gathered. The study is using computational analysis to draw inferences from the case studies collected in the databases of the hospitals. The types and characteristics of occupational injuries at home and outdoor are compared and analyzed. The purpose of the study is to present the findings from recent case studies for future reference and to recommend useful roles for the industrial sector in the care of patients with hand trauma in order to lower occupational harm. The injuries of preschool children are also analyzed. The incidence rate of hand injuries in infants has been increasing year by year which is directly related to the inefficient growth of children in rural areas. The data are collected from hospitals, then the data analytical tools are applied to draw conclusions. The suggested model is intelligently learned through the application of computational techniques, which are also used to suggest treatments to trauma victims. According to this study, males are more likely than females to sustain hand trauma; occupational injuries are more common than living injuries; males between the ages of 20 and 50 are at an increased risk of suffering an occupational injury. This study showed that the proportion of hand trauma in preschool children was higher (12.27%), and the 2-3-year-old group was the main injury target of preschool children (45.70%). The accidental injuries of newborns and young children can be reduced by government assistance, social support, and tighter monitoring.
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Hollin IL, Bonilla B, Bagley A, Tucker CA. Social and environmental determinants of health among children with long-term movement impairment. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:831070. [PMID: 36188898 PMCID: PMC9397841 DOI: 10.3389/fresc.2022.831070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/13/2022] [Indexed: 11/13/2022]
Abstract
The healthcare research community increasingly recognizes the need to address social (SDOH) and environmental determinants of health (EDOH) to optimize health and healthcare. This is particularly relevant to disability and functioning and to those with child onset conditions that impair mobility and impact functioning and participation. Using the World Health Organization (WHO)'s International Classification of Functioning, Disability, and Health (ICF) as a comprehensive framework, this paper aims to discuss our understanding of the relationships between social and EDOH and outcomes among people with impaired mobility that impacts functioning. This paper offers suggestions for future developments and guidance to use SDOH and EDOH in research and clinical practice.
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Affiliation(s)
- Ilene L. Hollin
- Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, United States
- *Correspondence: Ilene L. Hollin
| | - Bethney Bonilla
- Center for Healthcare Policy and Research, University of California, Davis, Davis, CA, United States
- Bethney Bonilla
| | - Anita Bagley
- Clinical Research, Shriners Hospitals for Children, Northern California, Sacramento, CA, United States
| | - Carole A. Tucker
- Department of Nutrition, Metabolic and Rehabilitation Sciences, University of Texas Medical Branch, School of Health Professions, Galveston, TX, United States
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Stonner MM, Keane G, Berlet L, Goldfarb CA, Pet MA. The Impact of Social Deprivation and Hand Therapy Attendance on Range of Motion After Flexor Tendon Repair. J Hand Surg Am 2022; 47:655-661. [PMID: 35623922 DOI: 10.1016/j.jhsa.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the influence of social deprivation and hand therapy attendance on active range of motion (AROM) outcomes following flexor tendon repair. METHODS We performed a retrospective analysis of patients who underwent primary zone I-III flexor tendon repair between November 2016 and November 2020. Area deprivation index (ADI) was used to quantify social deprivation. Medical record review determined each patient's demographic characteristics, injury details, total hand therapy visits, and final AROM outcome. Active range of motion was converted to Strickland's percentage for analysis. Spearman correlation and simple and multivariable linear regression models were used to assess relationships between explanatory variables and outcomes. RESULTS There were a total of 109 patients, with a mean ADI of 53 and mean therapy attendance of 13 visits. Higher ADI and lower therapy attendance were correlated, and each was associated with significantly decreased Strickland's percentage. In the multivariable model, therapy attendance, ADI, zone 2 injury, and age maintained significant associations with Strickland's percentage. CONCLUSIONS Socially deprived patients attend fewer therapy sessions and obtain poorer AROM after flexor tendon repair. Social deprivation is likely to contribute to poor outcomes both by its association with decreased therapy attendance and by other potential pathways that make it difficult for deprived patients to achieve good surgical outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Macyn M Stonner
- Milliken Hand Rehabilitation Center, Washington University School of Medicine, St. Louis, MO.
| | - Grace Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Logan Berlet
- Milliken Hand Rehabilitation Center, Washington University School of Medicine, St. Louis, MO
| | - Charles A Goldfarb
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
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Sensitivity Analysis and Quantification of the Role of Governing Transport Mechanisms and Parameters in a Gas Flow Model for Low-Permeability Porous Media. Transp Porous Media 2022. [DOI: 10.1007/s11242-022-01755-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractRecent models represent gas (methane) migration in low-permeability media as a weighted sum of various contributions, each associated with a given flow regime. These models typically embed numerous chemical/physical parameters that cannot be easily and unambiguously evaluated via experimental investigations. In this context, modern sensitivity analysis techniques enable us to diagnose the behavior of a given model through the quantification of the importance and role of model input uncertainties with respect to a target model output. Here, we rely on two global sensitivity analysis approaches and metrics (i.e., variance-based Sobol’ indices and moment-based AMA indices) to assess the behavior of a recent interpretive model that conceptualizes gas migration as the sum of a surface diffusion mechanism and two weighted bulk flow components. We quantitatively investigate the impact of (i) each uncertain model parameter and (ii) the type of their associated probability distribution on the evaluation of methane flow. We then derive the structure of an effective diffusion coefficient embedding all complex mechanisms of the model considered and allowing quantification of the relative contribution of each flow mechanism to the overall gas flow.
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Nezwek TA, Braun SV, Menendez ME, Grussing ED, Shabin ZM. Area Deprivation Index and Magnitude of Scoliosis at Presentation to a Tertiary Referral Scoliosis Clinic in Massachusetts. J Pediatr Orthop 2021; 41:e712-e716. [PMID: 34354029 DOI: 10.1097/bpo.0000000000001869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is growing interest in identifying predictors of large scoliosis curves at initial presentation, but few data to guide such preventive efforts. The association of neighborhood socioeconomic deprivation with curve magnitude in this context has not been previously evaluated. The purpose of our study was to determine the correlation of socioeconomic deprivation with scoliosis curve magnitude at initial presentation. Secondarily, we assessed the correlation of body mass index (BMI) with curve severity. METHODS We retrospectively identified 202 patients presenting with adolescent idiopathic scoliosis to a single tertiary care center in Massachusetts from January 2015 to August 2018. The Area Deprivation Index (ADI), a validated composite measure of neighborhood socioeconomic deprivation, was calculated for each patient. Curve magnitude, age, sex, BMI, race, and insurance status were recorded. Pearson correlation was used to determine the association of the ADI and BMI with scoliosis severity. RESULTS There was no correlation between the ADI and the magnitude of scoliosis at presentation (r=0.055; P=0.43). Greater BMI was moderately correlated with increased scoliosis curve magnitude (r=0.28; P<0.001). There was no association between curve magnitude and patient age, sex, race, or insurance status. CONCLUSIONS The finding that neighborhood socioeconomic deprivation did not correlate with greater scoliosis severity at presentation may be suggestive of equitable access to specialized scoliosis care. Future research should determine whether this reassuring finding is unique to Massachusetts--a state with high rates of health insurance coverage--or generalizable to other US states. In addition, our study further corroborates the notion that greater BMI is associated with larger scoliosis curves, and calls for targeted interventions to facilitate early scoliosis detection in the growing childhood obese population. LEVEL OF EVIDENCE Level II-prognostic study and retrospective study.
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Affiliation(s)
- Teron A Nezwek
- Department of Orthopaedic Surgery, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA
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Evaluation of Patient Expectations before Carpal Tunnel Release. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3823. [PMID: 34584826 PMCID: PMC8460224 DOI: 10.1097/gox.0000000000003823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 01/29/2023]
Abstract
Background: Carpal tunnel release (CTR) is common, yet patient treatment expectations remain unclear. The primary purpose was to describe patient expectations before CTR. Secondarily, we aimed to identify factors influencing expectations. Methods: Included patients underwent unilateral or bilateral CTR between 2015 and 2017 at a single academic center. Expectations regarding the level of relief/improvement were queried. Area deprivation index (ADI) was used to measure social deprivation. Univariate and multivariable logistic regression identified factors associated with expecting great relief/improvement. Results: Of 307 included patients, mean age was 54 ± 16 years and 63% were women. Patients most commonly expected great (58%) or some (23%) relief/improvement. Few patients expected little (3%) or no (4%) relief/improvement, and 13% had no expectations. In the multivariable analysis, male sex, lower social deprivation, and lower BMI were associated with expecting great relief/improvement. Age, surgical technique (open versus endoscopic), use of the operating room versus procedure room, and preoperative factors (constant numbness, weakness/atrophy, duration of symptoms, and QuickDASH) were not associated with expectations. Conclusions: Most patients expect some to great improvement after CTR. This was independent of several factors with a known association with worse outcomes (advanced age, atrophy/weakness, and constant numbness). Male sex was associated with the expectation of great improvement, in which superior outcomes relative to females have not been borne out in the literature. These findings highlight patient counseling opportunities. The observed association between social deprivation and expectations warrants further investigation, as the socioeconomically disadvantaged experience worse healthcare outcomes in general.
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Rassu FS, McFadden M, Aaron RV, Wegener ST, Ephraim PL, Lane E, Brennan G, Minick KI, Fritz JM, Skolasky RL. The Relationship between Neighborhood Deprivation and Perceived Changes for Pain-Related Experiences among U.S. Patients with Chronic Low Back Pain during the COVID-19 Pandemic. PAIN MEDICINE 2021; 22:2550-2565. [PMID: 34181008 DOI: 10.1093/pm/pnab179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Disruptions caused by the COVID-19 pandemic could disproportionately affect the health of vulnerable populations, including patients experiencing persistent health conditions (i.e., chronic pain), along with populations living within deprived, lower socioeconomic areas. The current cross-sectional study characterized relationships between neighborhood deprivation and perceived changes in pain-related experiences during the COVID-19 pandemic (early-September to mid-October 2020) for adult patients (N = 97) with nonspecific chronic low back pain. METHODS We collected self-report perceived experiences from participants enrolled in an ongoing pragmatic randomized trial across medical centers within the Salt Lake City, Utah and Baltimore, Maryland metropolitans. The Area Deprivation Index (composite of 17 U.S. Census deprivation metrics) reflected neighborhood deprivation based on participants' zip codes. RESULTS Although those living in the neighborhoods with greater deprivation endorsed significantly poorer physical (pain severity, pain interference, physical functioning), mental (depression, anxiety), and social health during the pandemic, there were no significant differences for perceived changes in pain-related experiences (pain severity, pain interference, sleep quality) between levels of neighborhood deprivation since the onset of the pandemic. However, those in neighborhoods with greater deprivation endorsed disproportionately worse perceived changes in pain coping, social support, and mood since the pandemic. CONCLUSIONS The current findings offer evidence that changes in pain coping during the pandemic may be disproportionately worse for those living in deprived areas. Considering poorer pain coping may contribute to long-term consequences, the current findings suggest the need for further attention and intervention to reduce the negative affect of the pandemic for such vulnerable populations.
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Affiliation(s)
- Fenan S Rassu
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Molly McFadden
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patti L Ephraim
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Lane
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Gerard Brennan
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kate I Minick
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Evans S, Okoroafor UC, Calfee RP. Is Social Deprivation Associated with PROMIS Outcomes After Upper Extremity Fractures in Children? Clin Orthop Relat Res 2021; 479:826-834. [PMID: 33196588 PMCID: PMC8083841 DOI: 10.1097/corr.0000000000001571] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously found that social deprivation was associated with worse perceived function and pain among children presenting with upper extremity fractures. We performed the current study to determine whether this differential in outcome scores would resolve after children received orthopaedic treatment for their fractures. This was needed to understand whether acute pain and impaired function were magnified by worse social deprivation or whether social deprivation was associated with differences in health perception even after injury resolution. QUESTIONS/PURPOSES Comparing patients from the least socially deprived national quartile and those from the most deprived quartile, we asked: (1) Are there differences in age, gender, race, or fracture location among children with upper extremity fractures? (2) After controlling for relevant confounding variables, is worse social deprivation associated with worse self-reported Patient-Reported Outcomes Measurement Information System (PROMIS) scores before and after the treatment of pediatric upper extremity fractures? (3) Is social deprivation associated with PROMIS score improvements as a result of fracture treatment? METHODS In this this retrospective, comparative study, we considered data from 1131 pediatric patients (aged 8 to 17 years) treated nonoperatively at a single tertiary academic medical center for isolated upper extremity fractures between June 2016 and June 2017. We used the Area Deprivation Index to define the patient's social deprivation by national quartiles to analyze those in the most- and least-deprived quartiles. After excluding patients with missing zip codes (n = 181), 18% (172 of 950) lived in the most socially deprived national quartile, while 31% (295 of 950) lived in the least socially deprived quartile. Among these 467 patients in the most- and least-deprived quartiles, 28% (129 of 467) were excluded for lack of follow-up and 9% (41 of 467) were excluded for incomplete PROMIS scores. The remaining 297 patients were analyzed (107 most-deprived quartile, 190 least-deprived quartile) longitudinally in the current study; they included 237 from our initial cross-sectional investigation that only considered reported health at presentation (60 patients added and 292 removed from the 529 patients in the original study, based on updated Area Deprivation Index quartiles). The primary outcomes were the self-completed pediatric PROMIS Upper Extremity Function, Pain Interference, and secondarily PROMIS Peer Relationships computer-adaptive tests. In each PROMIS assessment, higher scores indicated more of that domain (such as, higher function scores indicate better function but a higher pain score indicates more pain), and clinically relevant differences were approximately 3 points. Bivariate analysis compared patient age, gender, race, fracture type, and PROMIS scores between the most- and least-deprived groups. A multivariable linear regression analysis was used to determine factors associated with the final PROMIS scores. RESULTS Between the two quartiles, the only demographic and injury characteristic difference was race, with Black children being overrepresented in the most-deprived group (most deprived: white 53% [57 of 107], Black 45% [48 of 107], other 2% [2 of 107]; least deprived: white 92% [174 of 190], Black 4% [7 of 190), other 5% [9 of 190]; p < 0.001). At presentation, accounting for patient gender, race, and fracture location, the most socially deprived quartile remained independently associated with the initial PROMIS Upper Extremity (β 5.8 [95% CI 3.2 to 8.4]; p < 0.001) scores. After accounting for patient gender, race, and number of days in care, we found that the social deprivation quartile remained independently associated with the final PROMIS Upper Extremity (β 4.9 [95% CI 2.3 to 7.6]; p < 0.001) and Pain Interference scores (β -4.4 [95% CI -2.3 to -6.6]; p < 0.001). Social deprivation quartile was not associated with any differential in treatment impact on change in PROMIS Upper Extremity function (8 ± 13 versus 8 ± 12; mean difference 0.4 [95% CI -3.4 to 2.6]; p = 0.79) or Pain Interference scores (8 ± 9 versus 6 ± 12; mean difference 1.1 [95% CI -1.4 to 3.5]; p = 0.39) from presentation to the conclusion of treatment. CONCLUSION Delivering upper extremity fracture care produces substantial improvement in pain and function that is consistent regardless of a child's degree of social deprivation. However, as social deprivation is associated with worse perceived health at treatment initiation and conclusion, prospective interventional trials are needed to determine how orthopaedic surgeons can act to reduce the health disparities in children associated with social deprivation. As fractures prompt interaction with our health care system, the orthopaedic community may be well placed to identify children who could benefit from enrollment in proven community health initiatives or to advocate for multidisciplinary care coordinators such as social workers in fracture clinics. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Sophia Evans
- S. Evans, U. C. Okoroafor, R. P. Calfee, Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Johnson NA, Darwin O, Chasiouras D, Selby A, Bainbridge C. The effect of social deprivation on the incidence rate of carpal and cubital tunnel syndrome surgery. J Hand Surg Eur Vol 2021; 46:265-269. [PMID: 32677495 DOI: 10.1177/1753193420939384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We sought to establish whether carpal and cubital tunnel syndrome requiring surgery is associated with deprivation in England. Data from 10,496 adult patients who were treated in our hand unit over a 20-year period were reviewed. The Index of Multiple Deprivation was used to measure deprivation from the patients' postcode. The mean age at surgery in the most deprived three quintiles was significantly lower than in the least deprived two quintiles for carpal tunnel release (55 vs 59 years, respectively) and cubital tunnel release (52 vs 57 years, respectively). The incidence rate was significantly lower for the three least deprived quintiles when compared with the most deprived quintile for both conditions. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for carpal tunnel release was 0.70 for men and 0.76 for women. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for cubital tunnel release was 0.79 for men and 0.49 for women. Carpal tunnel and cubital tunnel syndrome requiring surgery is more common in deprived patients and occurs at an earlier age.Level of evidence: IV.
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Affiliation(s)
| | - Oliver Darwin
- Pulvertaft Hand Centre, Derby, UK.,University of Nottingham, Nottingham, UK
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Social Deprivation and Congenital Upper Extremity Differences-An Assessment Using PROMIS. J Hand Surg Am 2021; 46:114-118. [PMID: 33097335 DOI: 10.1016/j.jhsa.2020.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Social deprivation, a measure of socioeconomic status, has been shown to negatively affect perceptions of orthopedic conditions and outcomes of treatment. The objective of this study was to assess whether social deprivation correlates with subjective assessment of function in pediatric patients with congenital hand differences. METHODS Patients enrolled in the Congenital Upper Limb Differences (CoULD) registry were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). The PROMIS scores for Pain Interference, Peer Relations, Anxiety, Depression, and Upper Extremity (UE) function were obtained for all patients 5 years and older at initial presentation. Social deprivation was determined by the Area Deprivation Index (ADI); the index ranges from 0 to 100 with higher scores being the most deprived. The PROMIS scores were correlated with the ADI for all patients. RESULTS Three hundred seventy-five pediatric patients with congenital UE differences were evaluated. Average age was 11 years, 56% were female, and 55% had bilateral involvement. Overall, PROMIS scores were within 1 SD of normal for Peer Relations, Pain, Depression, and Anxiety. However, child-reported scores for UE function (39) were more than 1 SD below the national average (50). The mean ADI for the cohort was lower than the national average, indicative of less deprivation, with 14% of patients in the most deprived national quartile. Children in the highest ADI quartile reported PROMIS scores that reflected higher Pain Interference (41 vs 45), lower Peer Relations (55 vs 50), higher Anxiety (44 vs 49), and higher Depression (43 vs 47) than children in the lowest ADI quartile. CONCLUSIONS The PROMIS scores were normal for psychosocial measures in children with congenital hand differences when evaluated as an entire cohort. However, child self-reported PROMIS scores for Pain Interference, Peer Relations, Anxiety, and Depression were worse in more socially deprived areas, suggesting more psychosocial challenges in these children. CLINICAL RELEVANCE Pediatric patients with congenital upper extremity differences in areas of higher social deprivation report lower psychosocial well-being. The care of these individuals must be considered within the context of their environment because they may be more at risk for negative outcomes secondary to environmental and societal stressors.
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Hand Surgery Transfers to Level 1 Center: Variables Affecting Transfer Method and Diagnostic Accuracy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3279. [PMID: 33425593 PMCID: PMC7787344 DOI: 10.1097/gox.0000000000003279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 10/29/2022]
Abstract
We hypothesize that some costly patient transfers to a level 1 trauma center for hand specialist management may be unnecessary. This analysis evaluates transfer cost effectiveness and whether time of consult, transfer distance, diagnosis at time of transfer, and provider level influence diagnostic accuracy and transport method. Methods Two hundred and sixty-five patients transferred to a suburban level 1 trauma center for hand surgeon evaluation between 2014 and 2019 were evaluated for patient and injury characteristics, time of consult, transfer distance, provider level, transport method, treatment cost, and diagnostic accuracy. Results The average patient age was 36.2 years, and 80.3% were men. 21% of transfers had inaccurate pre-transfer diagnoses, and certain pre-transfer diagnoses correlated with an increased likelihood of inaccuracy, including flexor tenosynovitis and vascular injury. Patients with a language barrier had a greater likelihood of being transferred with an inaccurate diagnosis (P < 0.05). Compared with ground transport, air ambulance was associated with a higher cost of treatment ($225,679 versus $133,887, P < 0.00001). Of all transfers, 14 (5%) were discharged from the emergency department (ED) without a procedure, 9 (3%) were admitted for observation, 73 (27%) had an ED procedure before discharge, and 166 (62%) received operative management. Conclusions Over 30% of transfers to a level 1 trauma center likely could have been managed at the transferring facility at a decreased cost. Certain diagnoses are associated with increased risk for diagnostic error and unnecessarily urgent transport. Providers can use this information to consider transfer patterns and to educate transferring providers.
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Meza BC, Iacone D, Talwar D, Sankar WN, Shah AS. Socioeconomic Deprivation and Its Adverse Association with Adolescent Fracture Care Compliance. JB JS Open Access 2020; 5:e0064. [PMID: 33123665 PMCID: PMC7418910 DOI: 10.2106/jbjs.oa.19.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Socioeconomic deprivation increases fracture incidence in adolescents, but
its impact on fracture care is unknown. The area deprivation index (ADI),
which incorporates 17 factors from the U.S. Census, measures socioeconomic
deprivation in neighborhoods. This investigation aimed to determine the
impact of socioeconomic deprivation and other socioeconomic factors on
fracture care compliance in adolescents. Methods: This study included patients who were 11 to 18 years of age and received
fracture care at a single urban children’s hospital system between
2015 and 2017. Demographic information (sex, race, caregiver status,
insurance type) and clinical information (mechanism of injury, type of
treatment) were obtained. The ADI, which has a mean score of 100 points and
a standard deviation of 20 points, was used to quantify socioeconomic
deprivation for each patient’s neighborhood. The outcome variables
related to compliance included the quantity of no-show visits at the
orthopaedic clinic and delays in follow-up care of >1 week. Risk
factors for suboptimal compliance were evaluated by bivariate analysis and
multivariate logistic regression. Results: The cohort included 457 adolescents; 75.9% of the patients were male, and the
median age was 16.1 years. The median ADI was 101.5 points (interquartile
range, 86.3 to 114.9 points). Bivariate analyses demonstrated that higher
ADI, black race, single-parent caregiver status, Medicaid insurance,
non-sports mechanisms of injury, and surgical management are associated with
suboptimal fracture care compliance. Adolescents from the most socially
deprived regions were significantly more likely to have delays in care
(33.8% compared with 20.1%; p = 0.037) and miss scheduled orthopaedic
visits (29.9% compared with 7.1%; p < 0.001) compared with adolescents
from the least deprived regions. ADI, Medicaid insurance, and initial
presentation to the emergency department were independent predictors of
suboptimal care compliance, when controlling for other variables. Conclusions: Socioeconomic deprivation is associated with an increased risk of suboptimal
fracture care compliance in adolescents. Clinicians can utilize caregiver
and insurance status to better understand the likelihood of fracture care
compliance. These findings highlight the importance of understanding
differences in each family’s ability to adhere to the recommended
follow-up and of implementing measures to enhance compliance.
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Affiliation(s)
- Blake C Meza
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dina Iacone
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Divya Talwar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wudbhav N Sankar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Apurva S Shah
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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The effect of social deprivation on fragility fracture of the distal radius. Injury 2019; 50:1232-1236. [PMID: 31076143 DOI: 10.1016/j.injury.2019.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Social deprivation is associated with many adult fractures including distal radius fractures but the mechanisms for this are unclear. The aim of this study was to identify if social deprivation was associated with falls risk, mechanism of injury or osteoporosis in patients with a fragility fracture of the distal radius. METHOD Details of all patients aged 50 years and over presenting with a radiographically confirmed fracture of the distal radius over a one year period, were prospectively recorded. Patients were sent a questionnaire pack including questions regarding place and mechanism of injury, comorbidity assessment, falls risk assessment tool and FRAX assessment of bone health and fracture risk. RESULTS 333 out of 521 eligible patients completed the questionnaire (279 female; 54 male, response rate = 64%). There was no difference between characteristics of responders and non-responders (p = 0.58). DRF rate was higher in socially deprived quintiles (p = 0.040). Less falls occurred in the home in socially deprived patients (Q1/2: 35%: Q3-5: 48%, p = 0.037) with more falls outdoors (Q1/2: 39%: Q3-5: 24%, p = 0.001). There was no difference in height from which falls took place with most occurring from standing height (Q1/2: 81%: Q3-5: 86%, p = 0.336). Linear regression analysis found no relationship between social deprivation rank and FRAX scores (major fracture risk: p = 0.274, hip fracture risk: p = 0.283) but demonstrated a significant relationship between social deprivation and increased number of falls risk factors (p = 0.002). Mean number of falls risk factors was higher in the two most socially deprived quintiles (Q1/2: 3.62: Q3-5: 2.79, p = 0.028). CONCLUSION We have identified increased falls risk as an important reason for DRF in socially deprived patients. Knowing which patients are at highest risk allows interventions to be efficiently targeted. We would recommend resources should be targeted towards patients from socially deprived areas and focused on specific falls prevention strategies.
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Johnson NA, Jeffery J, Stirling E, Thompson J, Dias JJ. Effects of deprivation, ethnicity, gender and age on distal radius fracture incidence and surgical intervention rate. Bone 2019; 121:1-8. [PMID: 30599298 DOI: 10.1016/j.bone.2018.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/28/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Social deprivation has been shown to be associated with increased incidence of many types of fracture but the causes for this have not been established. The aim of this study was to establish if distal radius fracture was associated with deprivation and investigate reasons for this. METHOD Data was reviewed of 4463 adult patients who attended our Emergency Department over a four year period. The Index of Multiple Deprivation was used to measure deprivation for each patient. Modelling techniques were used to investigate the relationship between fracture rate and deprivation, gender, ethnicity and age. RESULTS Distal radius fracture rate was higher for patients in more deprived quintiles. Mean age in the most deprived two quintiles was 54.4 years compared to 60.1 years in the least deprived three quintiles. Modelling showed important differences between ethnic groups. Deprivation was an independent risk factor for distal radius fracture only in white patients. Deprived white women had a lower second metacarpal cortical index than women of other ethnicities suggesting increased bone fragility. Being male is a risk factor for fracture when deprivation, ethnicity and age are taken into account. Incidence rate ratio of the least deprived quintile compared to the most deprived was 0.33 (95% CI: 0.30-0.37) for white men and 0.47 (95% CI: 0.44-0.49) for white women. CONCLUSION Effective interventions exist to prevent further fragility fracture and this work allows geographical areas at risk to be identified. Presentation with a distal radius fracture provides an opportunity to implement interventions. In the current economic climate resources are scarce and must be used prudently. Resources should be targeted to those at risk patients from deprived areas and preventative strategies put in place.
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Affiliation(s)
- Nick A Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
| | - John Jeffery
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - Euan Stirling
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Joseph J Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK
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18
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The Impact of Social Deprivation on Pediatric PROMIS Health Scores After Upper Extremity Fracture. J Hand Surg Am 2018; 43:897-902. [PMID: 30232023 DOI: 10.1016/j.jhsa.2018.06.119] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/08/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Although social deprivation is acknowledged to influence physical and mental health in adults, it is unclear if and how social deprivation influences perceived health in children. This study was conducted to evaluate the impact of social deprivation on Patient-Reported Outcomes Measurement Information System (PROMIS) scores in children presenting for treatment of upper extremity fractures. METHODS This cross-sectional evaluation analyzed data from 975 new pediatric patients (8-17 years old) with upper extremity fractures presenting to a tertiary orthopedic center between June 1, 2016, and June 1, 2017. They completed self-administered PROMIS Computer Adaptive Tests (CATs). The Area Deprivation Index was used to quantify social deprivation. Bivariate statistical analysis determined the effect of disparate area deprivation (based on most and least deprived national quartiles) for the entire population. RESULTS A total of 327 children (34%) lived in areas categorized as the most socially deprived quartile of the United States, whereas 202 (21%) arrived from homes in the least socially deprived quartile. Children in the most deprived quartile had significantly worse mean PROMIS Upper Extremity Function, Mobility, Pain Interference, and Peer Relations scores than those in the least deprived quartile. Significantly more children from the most socially deprived areas were black. Patient age, sex, and fracture type were not significantly different between patients from the least and the most socially deprived quartiles. CONCLUSIONS Children living in areas of greatest social deprivation report worse Upper Extremity Function, Mobility, Pain Interference, and Peer Relations scores on self-administered PROMIS CATs than children from areas of least social deprivation at presentation for care of upper extremity fractures. The impact of social deprivation on perceived health and function is evident before adulthood and, therefore, interventions to mitigate this effect should be offered to children as well as adults. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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19
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Ultee KHJ, Tjeertes EKM, Bastos Gonçalves F, Rouwet EV, Hoofwijk AGM, Stolker RJ, Verhagen HJM, Hoeks SE. The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare. PLoS One 2018; 13:e0191464. [PMID: 29357383 PMCID: PMC5777644 DOI: 10.1371/journal.pone.0191464] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 01/05/2018] [Indexed: 11/19/2022] Open
Abstract
Background The impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications. Methods Patients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES–quantified by gross household income–with major 30-day complications and long-term postoperative survival. Results A total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01–1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08–2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07–1.48, first income quartile: HR: 3.10, 95% CI: 1.04–9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications. Conclusions Low SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.
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Affiliation(s)
- Klaas H. J. Ultee
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elke K. M. Tjeertes
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frederico Bastos Gonçalves
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ellen V. Rouwet
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Robert Jan Stolker
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hence J. M. Verhagen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sanne E. Hoeks
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- * E-mail:
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20
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Zoni AC, Domínguez-Berjón MF, Esteban-Vasallo MD, Velázquez-Buendía LM, Blaya-Nováková V, Regidor E. Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain. J Public Health (Oxf) 2018; 39:45-51. [PMID: 26869695 DOI: 10.1093/pubmed/fdw005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Socioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age. Methods This was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed. Results A statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15-44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group. Conclusion People with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age.
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Affiliation(s)
- Ana Clara Zoni
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | | | - María D Esteban-Vasallo
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | - Luis M Velázquez-Buendía
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | - Vendula Blaya-Nováková
- Agency for Health Technology Assessment, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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21
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Abstract
Scaphoid fractures account for 2% of all fractures. In Europe, the incidence is 12.4/100,000/y. This article focuses on the European perspective on understanding and management of these injuries. These fractures occur in young, active patients. The aim of treatment is union. Osteoarthritis is almost inevitable if the fracture does not unite. Cast immobilization is the treatment of choice in occult or stable fractures with 90% to 95% healing. Acute/primary surgery may be considered in some patients. The European literature stresses the importance of taking the patient's wishes into consideration after careful counseling about alternative treatment methods.
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Affiliation(s)
- Joseph Dias
- University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
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22
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Impact of Safety Net Hospitals in the Care of the Hand-Injured Patient: A National Perspective. Plast Reconstr Surg 2017; 138:429-434. [PMID: 27465165 DOI: 10.1097/prs.0000000000002373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A clear disparity in the pattern and provision of surgical care exists, particularly for patients with vulnerable socioeconomic backgrounds. For hand-injured patients in particular, this discrepancy has been frequently shown in their receiving appropriate care. With the advent of the Affordable Care Act and with Medicaid expansion on the horizon, more patients will be requiring access to care. Safety net programs have been shown to provide equivalent levels of care for patients compared with non-safety net providers, and the survival of these hospitals for the disadvantaged is essential to providing quality care for this growing patient population. In this article, the authors review the factors that affect the barriers to care, the importance of safety net hospitals, the epidemiology of the hand-injured patient, and how the Affordable Care Act will impact these safety net programs.
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23
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Low L, Hodson J, Morris D, Desai P, MacEwen C. Socioeconomic deprivation and serious ocular trauma in Scotland: a national prospective study. Br J Ophthalmol 2017; 101:1395-1398. [PMID: 28274942 PMCID: PMC5629949 DOI: 10.1136/bjophthalmol-2016-309875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 11/17/2022]
Abstract
Objective To identify the population at risk of serious ocular trauma by exploring relationships with socioeconomic factors. Design National, prospective, population-based, cross-sectional and follow-up study. Participants Patients with serious ocular trauma requiring hospital admission in Scotland. Methods Case definition and ascertainment—cases of serious ocular trauma necessitating admission to hospital under the care of a consultant ophthalmologist were identified using the British Ophthalmological Surveillance Unit reporting scheme. Using the postcode of residence, we assigned a Scottish Index of Multiple Deprivation (SIMD) score, SIMD quintile ( 0%–20% most deprived; 20%–40%, 40%–60%, 60%–80%, 80%–100% least deprived areas), geographical access score as well as the estimated travel time to the nearest general practitioner (GP) practice using either car or public transport for each patient. Population estimates were obtained from the General Register Office for Scotland. Main outcome measure Serious ocular trauma requiring hospital admission. Results A total of 104 patients (85.6% male) were reported as being admitted with ocular trauma with a median age of 32 years (IQR 24–54). There was a trend for increasing incidence of serious ocular injury with increasing socioeconomic deprivation (p=0.034). Patients from the most deprived areas (SIMD: 0%–20%) were twice as likely to sustain ocular injury compared with those from the least deprived (SIMD: 80%–100%) areas (relative risk: 2.19, 95% CI 1.02 to 4.81). There was no significant difference in the drive/public transport time to GP practices across the SIMD quintiles. Conclusions Increasing socioeconomic deprivation was associated with a higher incidence of serious ocular injury. Targeted interventions are needed to address inequality in eye healthcare in deprived areas.
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Affiliation(s)
- Liying Low
- Academic Unit of Ophthalmology, University of Birmingham, Birmingham and Midland Eye Centre, Birmingham, UK
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Daniel Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, Wales, UK
| | - Parul Desai
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline MacEwen
- Department of Ophthalmology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Grivna M, Eid HO, Abu-Zidan FM. Epidemiology of isolated hand injuries in the United Arab Emirates. World J Orthop 2016; 7:570-576. [PMID: 27672570 PMCID: PMC5027012 DOI: 10.5312/wjo.v7.i9.570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/25/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To provide suggestions for hand injury prevention by study the demography and risk factors of casualties suffering from isolated hand injuries.
METHODS All trauma patients with isolated hand injuries who were admitted to Al Ain Hospital for more than 24 h during a period of 3 years were studied. Patient demographics, location, mechanism/time of injury, and length of hospital stay were all analyzed.
RESULTS Two hundred and ten patients were studied. Their mean age was 29.7 years. Males constituted 92%. Sixty-five point one percent of all cases were from the Indian subcontinent. The workplace was the most common location of injury (67.1%), followed by the home (17.1%) and road (6.2%). Machinery caused 36.2% of all injuries, followed by heavy object (20.5%) and fall (11%). Cases injured at home were young (P < 0.0001) with an associated higher incidence of females (P < 0.0001).
CONCLUSION Male workers in Al Ain city are at greater risk of sustaining hand injuries, predominantly from machinery. Safety education, personal protection, and the enforcement of safety standards are essential to the prevention and avoidance of hand injury.
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25
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Anakwe RE, Middleton SD, Bugler KE, Duckworth AD, McQueen MM, Brown CMC. Open Finger Fractures: Incidence, Patterns of Injury and the Influence of Social Deprivation. J Hand Surg Asian Pac Vol 2016; 21:352-6. [PMID: 27595953 DOI: 10.1142/s2424835516500338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study investigates the patterns and epidemiology of open finger fractures. There is little good data about these injuries. METHODS Data were collected prospectively in a single trauma unit serving a well-defined population. RESULTS Over a 15 year period 1090 open finger fractures were treated in 1014 patients. These made up the vast majority of open fractures treated in the trauma unit during this period. The incidence of open finger fractures was 14.0 per 100,000 patients per year. Deprivation did not influence the incidence of open finger fractures but did affect treatment choices for women. Most open finger fractures resulted from crush injuries or falls and required only simple operative treatments: debridement, lavage and early mobilization. CONCLUSIONS Open finger fractures formed the majority of the workload of open fractures at our trauma centre but usually required simple treatments only. Social deprivation was not shown to influence the patterns or epidemiology of these injuries but did affect treatment choices for women.
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Affiliation(s)
- Raymond E Anakwe
- † Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Scott D Middleton
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Kate E Bugler
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Margaret M McQueen
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Mohan A, Thomson RM, Titley G, Chester DL. Ten years of acute hand trauma: is day case surgery still working? A review of 726 patients. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid. Bone Joint J 2016; 98-B:654-9. [PMID: 27143737 DOI: 10.1302/0301-620x.98b5.36938] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/13/2015] [Indexed: 11/05/2022]
Abstract
Aims This study explores the epidemiology of patients with a fracture of the scaphoid presenting to a regional teaching hospital. Patients and Methods All patients with a confirmed fracture of the scaphoid over a retrospective period between January 2010 and May 2013 were included. Their demographics, deprivation status and when the fracture occurred was noted and assessed. There were 415 fractures in 365 males and 50 females. Results The incidence of fracture of the scaphoid was 12.4 in 100 000 each year in the general population. The mean age of the patients was 22 years (nine to 35); the highest incidence was in males aged between 15 and 19 years. We calculate the annual incidence in the United Kingdom to be 7265 each year. Patients with the lowest socioeconomic status had an incidence of 18.57 in 100 000 whereas the least deprived patients had an incidence of 9.98 (p < 0.001). There was evidence of a seasonal trend (p = 0.022) with the highest monthly rate found in June (16.96 in 100 000 each year) and the lowest was in December (7.61 in 100 000 each year). There were significantly fewer presentations of fracture at the weekend (p < 0.001), and the highest incidence was on Mondays. Most fractures occurred at the waist (64%) and tubercle (18.1%). Take home message: In this large-scale epidemiological study, we confirmed that young men are most at risk of sustaining a fracture of the scaphoid, and report new factors in relation to social deprivation and seasonality that influence scaphoid fractures. Cite this article: Bone Joint J 2016;98-B:654–9.
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Affiliation(s)
- K. Garala
- University Hospitals Coventry and Warwickshire, Coventry, CV2
2DX, UK
| | - N. A. Taub
- University of Leicester, 22-28
Princess Road West, Leicester LE1 6TP, UK
| | - J. J. Dias
- Leicester General Hospital, Gwendolen
Road, Leicester, LE5 4PW, UK
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28
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Finsen V. The influence of education and income on responses to the QuickDASH questionnaire. J Hand Surg Eur Vol 2015; 40:401-5. [PMID: 24916634 DOI: 10.1177/1753193414538874] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 05/13/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED We studied the influence of levels of income and education on QuickDASH scores. The scores were collected in a random sample of 1376 residents of Norway. The level of income was divided into four bands and level of education into five bands. The mean QuickDASH score for both men and women fell with every increase in education and income level. For women the mean score was 30 for those with the shortest education and 9 for those with the longest (p < 0.001). The corresponding figures for men were 19 and 7 (p < 0.01). The women with the lowest level of income had a mean score of 23, compared with 8 for women with the highest income level (p < 0.001). For men the corresponding mean scores were 20 and 5 (p < 0.001). Analysis of variance showed that age alone accounted for 16% of the variability of the scores among women and 7% among men. When levels of education and income were added to the analysis, these three factors accounted for 21% of the variability among women and 13% among men. We conclude that socioeconomic factors significantly influence QuickDASH scores. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- V Finsen
- Department of Orthopaedic Surgery, St. Olav's University Hospital and Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
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29
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Brennan SL, Yan L, Lix LM, Morin SN, Majumdar SR, Leslie WD. Sex- and age-specific associations between income and incident major osteoporotic fractures in Canadian men and women: a population-based analysis. Osteoporos Int 2015; 26:59-65. [PMID: 25278299 DOI: 10.1007/s00198-014-2914-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED We investigated sex- and age-specific associations between income and fractures at the hip, humerus, spine, and forearm in adults aged ≥50 years. Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. INTRODUCTION Associations between income and hip fractures are contested, even less is known about other fracture sites. We investigated sex- and age-specific associations between income and major osteoporotic fractures (MOF) at the hip, humerus, spine, and forearm. METHODS Incident fractures were identified from administrative health data for adults aged ≥50 years in Manitoba, Canada, 2000-2007. Mean neighborhood (postal code area) annual household incomes were extracted from 2006 census files and categorized into quintiles. We calculated age-adjusted and age-specific sex-stratified fracture incidence across income quintiles. We estimated relative risks (RR) and 95% CI for income quintile 1 (Q1, lowest income) vs. income quintile 5 (Q5) and tested the linear trend across quintiles. RESULTS We identified 15,094 incident fractures (4736 hip, 3012 humerus, 1979 spine, and 5367 forearm) in 2718 men and 6786 women. For males, the RR of fracture for the lowest vs. highest income quintile was 1.63 (95% CI 1.42-1.87) and the negative trend was statistically significant (p < 0.0001); individual skeletal sites showed similar associations. For females, the RR of fracture for the lowest vs. highest income quintile was 1.14 (95% CI 1.01-1.28), with a statistically significant negative trend (p = 0.0291); however, the only skeletal site associated with income in women was the forearm (Q1 vs. Q5 RR 1.09, 95% CI 1.01-1.28). CONCLUSIONS Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. For men, these effect sizes seem large enough to warrant public health concern.
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Affiliation(s)
- S L Brennan
- School of Medicine, Deakin University, Geelong, Australia
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Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 2014; 96:1716-23. [PMID: 25320198 DOI: 10.2106/jbjs.m.01354] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management. METHODS From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006). CONCLUSIONS Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Neil R Wickramasinghe
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Nicholas D Clement
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
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Lowe A, Campbell L, Ramaswamy B, Horobin H, McLean S. Does deprivation influence treatment outcome in physiotherapy? PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
PURPOSE Pain is not a classical symptom of carpal tunnel syndrome (CTS), with the exception of numbness that is so intense that it is described by patients as painful. The primary aim of our study was to determine which factors correlated with pain for patients diagnosed with CTS. METHODS We prospectively assessed all patients diagnosed with CTS in our unit over a 1-year period. We recorded demographic details for all patients, including past medical history, body mass index, smoking, and occupation. The diagnosis and severity of carpal tunnel syndrome were established through a combination of history, clinical assessment, and nerve conduction studies. Of 275 patients diagnosed and treated for CTS, 183 were women (67%), the mean age was 55 years (range, 22-87 y), and 166 cases were bilateral (60%). The mean body mass index was 29.5 kg/m2 (range, 17-48 kg/m2), and 81 patients smoked (30%). Patients completed a Short Form-McGill pain questionnaire (SF-MPQ) as a measure of pain at initial presentation. We assessed outcome 1 year after intervention using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. RESULTS We found no association between pain according to the SF-MPQ and the positive clinical signs of CTS or positive nerve conduction studies. Multivariate analysis demonstrated that smoking and bilateral disease independently correlated with the overall SF-MPQ, with similar findings on subanalysis. Independent factors associated with an increased improvement in the QuickDASH at 1 year were the presentation QuickDASH score, positive nerve conduction studies, and smoking. CONCLUSIONS The only independent factors that correlated with pain at presentation of CTS were smoking and bilateral disease. Pain according to the SF-MPQ was not associated with classical clinical findings of the disease or with positive findings on nerve conduction testing. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
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Garala K, Power R, Dias J. The influence of social deprivation on bone donation: a 10 year retrospective study. Cell Tissue Bank 2012; 14:489-94. [PMID: 22945417 DOI: 10.1007/s10561-012-9338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
An audit identifying all surgical bone donors over a 10 year period was conducted. Postcodes were used to link data from the index of multiple deprivation (IMD) 2007 to give each donor a deprivation score. An audit from 2000 to 2010 of primary total hip replacement (THR) patients was also conducted, and similarly a deprivation score was identified for each patient. IMD scores are split into quintiles. A high IMD score indicates a high degree of social deprivation. Conversely low IMD scores indicate a more affluent community. The mean IMD 2007 score was 13.36 (95% CI 13.12-13.60). The national mean IMD score is 21.7 (CI 21.52-21.88). The difference is significant (p < 0.0001). The mean IMD 2007 score of primary THR patients identified in the arthroplasty database was 19.19 (CI 19.00-19.38). The difference between the mean arthroplasty score and the mean score of donors is significant (p < 0.0001). The donation rate increases as social deprivation decreases from quintile to quintile in both: the older patients (CI 1.08-1.14; p < 0.0001) and the general population (CI 1.20-1.25; p < 0.0001). Bone donors are substantially less deprived than their donor pool of THR patients. Donor rates are consistently lower in quintiles which are more deprived.
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Duckworth AD, Clement ND, Jenkins PJ, Will EM, Court-Brown CM, McQueen MM. Socioeconomic deprivation predicts outcome following radial head and neck fractures. Injury 2012; 43:1102-6. [PMID: 22440531 DOI: 10.1016/j.injury.2012.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/05/2012] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is increasing evidence demonstrating an association between fracture epidemiology and socioeconomic status. However, the influence of socioeconomic deprivation on fracture outcome has not been documented before. The aim of this study was to determine if socioeconomic deprivation influenced the short-term outcome following a fracture of the radial head or neck. METHODS We identified from a prospective database all patients who sustained a radial head or neck fracture over an 18-month period. The primary outcome measure for this study was the patient-reported short musculoskeletal function assessment (SMFA). The Index of Multiple Deprivation (IMD) was used to quantify deprivation, and any correlation with functional outcome was determined. Multivariate regression analysis was used to determine the influence of deprivation on outcome once other significant demographic and fracture characteristics had been accounted for. RESULTS There were 200 patients in the study cohort, of which 107 (53.5%) were female and the mean age was 44 years (16-83). At a mean follow-up of 6 months the median SMFA score was 0.54 (0-55.4). The SMFA was found to be influenced by the IMD, with increasing deprivation associated with a poorer outcome (p=0.006). On multivariate analysis, the AO fracture classification, compensation and increasing deprivation were the only independent predictors of outcome (all p<0.05). CONCLUSIONS We have a shown a clear correlation between functional outcome and socioeconomic status, with the most deprived patients reporting a poorer outcome. Future work should be aimed at determining which aspects of deprivation influence patient outcome, with modifiable factors targeted in future health-care planning.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
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Jenkins PJ, Watts AC, Duckworth AD, McEachan JE. Socioeconomic deprivation and the epidemiology of carpal tunnel syndrome. J Hand Surg Eur Vol 2012; 37:123-9. [PMID: 21921068 DOI: 10.1177/1753193411419952] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Deprivation has been recognized as a major determinant of health and is associated with several musculoskeletal conditions. This study examines the effect of deprivation on the incidence of carpal tunnel syndrome using a regional prospective audit database. Over a 6 year period there were 1564 patients diagnosed with CTS with an annual incidence of 72/100,000 population. There was a significant difference in population incidence of CTS from the most deprived (81/100,000) to the least deprived (62/100,000) (p = 0.003). Functional impairment was higher in the most deprived group compared with the least (DASH 56 vs 48, p = 0.001). The most deprived group exhibited the greatest exposure to occupation vibration (42.7%), and had the greatest risk of bilateral disease (OR = 2.33, p < 0.001). We report an association between socioeconomic deprivation and carpal tunnel syndrome, with the disease being more likely to be bilateral and have a poorer DASH score in the most deprived patients.
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Affiliation(s)
- P J Jenkins
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, UK.
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Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of radial head and neck fractures. J Hand Surg Am 2012; 37:112-9. [PMID: 22119600 DOI: 10.1016/j.jhsa.2011.09.034] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/24/2011] [Accepted: 09/27/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to define the epidemiological characteristics of proximal radial fractures. METHODS Using a prospective trauma database of 6,872 patients, we identified all patients who sustained a fracture of the radial head or neck over a 1-year period. Age, sex, socioeconomic status, mechanism of injury, fracture classification, and associated injuries were recorded and analyzed. RESULTS We identified 285 radial head (n = 199) and neck (n = 86) fractures, with a patient median age of 43 years (range, 13-94 y). The mean age of male patients was younger when compared to female patients for radial head and neck fractures, with no gender predominance seen. Gender did influence the mechanism of injury, with female patients commonly sustaining their fracture following a low-energy fall. Radial head fractures were associated more commonly with complex injuries according to the Mason classification, while associated injuries were related to age, the mechanism of injury, and increasing fracture complexity. CONCLUSIONS Radial head and neck fractures have distinct epidemiological characteristics, and consideration for osteoporosis in a subset of patients is recommended. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
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ten Berg PWL, Ring D. Patients lost to follow-up after metacarpal fractures. J Hand Surg Am 2012; 37:42-6. [PMID: 22015075 DOI: 10.1016/j.jhsa.2011.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 08/04/2011] [Accepted: 08/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine factors associated with non-attendance at scheduled follow-up visits for treatment of metacarpal fractures, to improve subject retention in prospective investigations. METHODS This study included adult patients with metacarpal fractures seen in an outpatient hand clinic between 2004 and 2009. We assessed a number of variables (demographic, social, and injury-specific) that might be associated with failure to return for follow-up. The statistical analysis included both bivariate and multivariable models. RESULTS In a cohort of 335 patients (228 men and 107 women) with a mean age of 40 years (range, 18-88 y), independent factors associated with non-attendance were unmarried status (single or divorced), having no insurance, having an unemployed or disabled status, having an unknown work status, and having a small finger metacarpal neck fracture. CONCLUSIONS Patients who do not attend a scheduled 1-month follow-up after a single isolated metacarpal fracture are sociologically distinct from those who do attend. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Paul W L ten Berg
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Are extremity musculoskeletal injuries in children related to obesity and social status? A prospective observational study in a district general hospital. J Child Orthop 2011; 5:97-100. [PMID: 22468152 PMCID: PMC3058206 DOI: 10.1007/s11832-010-0320-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 11/29/2010] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Obesity is one of the several independent risk factors for the risk of fractures. Major epidemiological studies also suggested the social status of the patients to be a confounding factor. We aimed to look at the influence of obesity on fractures and to determine if the social status of the patients is a confounding factor. METHODS This is an observational study of 560 children with musculoskeletal injuries who presented over a period of 8 months and the data were collected prospectively. Obesity status and social deprivation index were estimated. RESULTS The prevalence of overweight and obese children was 29.9%. Twenty-four percent of the boys and 31% of the girls were obese (P = 0.2). In the group of most deprived areas, the prevalence of obesity increased to 40% in those needing admission for intervention. CONCLUSIONS Although there is a slight increase in obesity, there is no suggestion of increased rate of fractures in deprived areas. Upper limb injuries were more predominant, with distal radius fracture being the most common injury. Boys sustain fractures twice as often as girls. There is a tendency to increasing obesity with increasing age.
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Anakwe RE, Aitken SA, Cowie JG, Middleton SD, Court-Brown CM. The epidemiology of fractures of the hand and the influence of social deprivation. J Hand Surg Eur Vol 2011; 36:62-5. [PMID: 20709710 DOI: 10.1177/1753193410381823] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigates the relationship between the epidemiology of hand fractures and social deprivation. Data were collected prospectively in a single trauma unit serving a well-defined population. The 1382 patients treated for 1569 fractures of the metacarpals or phalanges represented an incidence of hand fracture of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Deprivation was not directly associated with the incidence of hand fracture. Common mechanisms of injury are gender specific. Fractures of the little finger metacarpal were common (27% of the total) and were associated with social deprivation in men (P = 0.017). For women, fractures where the mechanism of injury was unclear or the patient was intoxicated and could not recall the mechanism showed a clear association with deprivation. Affluent patients were more likely to receive operative treatment. Social deprivation influences both the pattern and management of hand fractures.
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Affiliation(s)
- R E Anakwe
- Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Menon MRG, Walker JL, Court-Brown CM. The epidemiology of fractures in adolescents with reference to social deprivation. ACTA ACUST UNITED AC 2008; 90:1482-6. [PMID: 18978270 DOI: 10.1302/0301-620x.90b11.21163] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A relationship between social deprivation and the incidence of fracture in adolescents has not previously been shown. We have used a complete fracture database to identify adolescents who sustained fractures in 2000. The 2001 Scottish census was used to obtain age-specific population and deprivation data according to the Carstairs score. Regression analysis determined the relationship between the incidence of fractures and social deprivation. We analysed 1574 adolescents with fractures (1083 male, 491 female). The incidence of fractures in this group was 21.8 per thousand (31.0 male, 13.1 female). Social deprivation predicted the incidence in adolescent males and females. The incidence of fractures of the proximal upper limb and distal radius in females was overwhelmingly influenced by socioeconomic factors. Males of 15 to 20 years of age were more likely to sustain fractures of the hand and carpus if they lived in economically depressed neighbourhoods.
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Affiliation(s)
- M R G Menon
- Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SU, UK
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Bello AK, Peters J, Rigby J, Rahman AA, El Nahas M. Socioeconomic status and chronic kidney disease at presentation to a renal service in the United Kingdom. Clin J Am Soc Nephrol 2008; 3:1316-23. [PMID: 18579673 DOI: 10.2215/cjn.00680208] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Low socioeconomic status (SES) is associated with both development and progression of chronic kidney disease (CKD). The impact of SES on severity of CKD at presentation to a renal service is less well known. This study investigated the relationship between SES and severity of CKD in a retrospective, cross-sectional analysis involving 1657 patients at the Sheffield Kidney Institute (Sheffield, UK). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS SES was assigned to each patient according to electoral ward of residence by postcode and ranked according to the corresponding British Index of Multiple Deprivation score, which comprises five deprivation quintiles (Q1, least deprived; Q5, most deprived). National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification of CKD was used for stratification and analysis. Binary logistic regression analysis was applied for the association of variables/risk factors with CKD (lower GFR) at presentation. RESULTS The age-adjusted prevalence of diagnosed CKD at presentation by area of residence, across the five deprivation quintiles, per million population was Q1 = 1495, Q2 = 3530, Q3 = 3398, Q4 = 3989, and Q5 = 19,599. Logistic regression models showed that living in the lowest SES quintile area (Q5) as compared with the highest SES (Q1) was associated with a greater risk for presenting with a lower estimated GFR, after adjustment for sociodemographic, lifestyle, and clinical variables. CONCLUSIONS Low SES is related to severity of CKD at presentation. Further studies are needed to examine this issue across the various SES categories in the United Kingdom.
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