More children with common fractures being treated at SickKids, study finds

By Jessamine Luck, Communications & Public Affairs intern

With anecdotal observations indicating that increasing numbers of children were presenting to SickKids with common, uncomplicated elbow and leg fractures, which did not require specialized orthopaedic surgery, a research team from The Hospital for Sick Children (SickKids) and the University of Toronto set out to investigate why.

The resulting study is published in the June 15 of CMAJ Open.

“Interestingly, there was a sense that many of these children with fractures were being transferred from outside hospitals but didn’t necessarily require the level of expertise and resources available at specialized hospitals like SickKids,” says Dr. Mark Camp, senior author of the study and Staff Orthopaedic Surgeon and Project Investigator at SickKids.

The research team found the number of patients admitted to SickKids with the two most common operatively treated paediatric fractures had been increasing every year from April 1, 2008 to March 31, 2015. The two types of fractures they studied were supracondylar humerus (SCH) fractures of the elbow and femur fractures. The annual incidence rate for patients with SCH fractures at SickKids increased by 7.5 per cent every year, while the incidence for patients with femur fractures increased by 5.3 per cent every year.

Meanwhile, from 2002 to 2015, the number of patients being treated at community hospitals for the same fractures decreased by four per cent every year. The number of patients with these fractures who were treated at other specialized paediatric centres in Ontario did not change significantly. For every 100 SCH cases in 2002, 11 were treated at SickKids, 36 at other paediatric centres and 53 in community hospitals. By 2015, those numbers had changed to 40 at SickKids, 35 at other paediatric centres and 25 in community hospitals.

The researchers noted that more than 70 per cent of patients with SCH and femur fractures every year were being transferred from other hospitals to SickKids, regardless of the complexity of the fracture and the type of surgery required for treatment.

“Although informal regionalization appears to be occurring in the GTA for paediatric fracture care, its effect on clinical outcomes and costs is unclear,” says lead author Dr. Daniel Pincus, orthopaedic resident and PhD candidate in clinical epidemiology at the University of Toronto. Further research is needed to assess the clinical impact of informally regionalized care, to determine if the phenomenon is found in other specialties, and to understand why it is
occurring.”

The study also found a significant increase in the number of patients with SCH fractures coming directly to SickKids. This, the researchers say, may mean parents prefer their children to be treated at a dedicated paediatric centre rather than at a community hospital.

The researchers note increases in transfers from outside hospitals and direct presentations are occurring independently of demographic changes and changes in clinical practice. Future areas of study for this research should focus on whether patients with these uncomplicated fractures are diverting resources away from patients with complex needs at SickKids.