ASSESSING PATIENT OUTCOMES FOLLOWING A FRACTURE

摘要

Background: Both primary care sports medicine physicians and orthopedic surgeons, in conjunction with advanced practice providers, often manage young patients with fractures. To our knowledge, no investigations have evaluated patient outcomes based on the type of provider they see for fracture management. This study examined fracture management, patient outcomes, and patient satisfaction in pediatric and adolescent patients with fibula, tibia, radius and ulna fractures. Specifically, we sought to determine if there were differences between patients seen by a primary care sports medicine physician or orthopedic surgeon/physician assistant (PA) on measures of time to clearance from the injury, patient-reported functional outcomes, and patient satisfaction. Methods: A retrospective chart review was performed for 4-18 year-old patients who were treated by a sports medicine provider (primary care or orthopedic surgeon/PA) for a fracture of the radius, ulna, tibia or fibula over the course of three months. We contacted patients approximately 10 months post-injury. Patients or their parents completed a patient satisfaction survey (Short Assessment of Patient Satisfaction [SPAS]) and an injury location-specific patient reported functional outcome tool: the Foot and Ankle Ability Measure (FAAM) was used for patients with fibular or tibia fractures; the Disabilities of the Arm, Shoulder, and Hand (DASH) Scale was used for patients with radius or ulna fractures. The SPAS is scored from 0-28 with higher scores indicating higher satisfaction. The DASH is scored from 0-110, while the FAAM is scored from 0-140. For the DASH and FAAM, 0 indicates the least disability. Results: 83 of 139 (60%) of patients who were contacted completed the study. 58 (70%) of patients were treated by pediatric primary care sports medicine physicians and 25 (30%) were treated by a pediatric sports medicine orthopedic surgeon or the surgeon’s PA. Both patient groups (Table 1) were of similar age (10.3±3.1 vs. 8.9±3.9 years; p= 0.09), proportion of females (47% vs. 36%; p= 0.47), proportion of upper extremity injuries (67% vs. 80%; p= 0.30), and number of x-rays obtained (3.2±3.5 vs. 3.5±1.8; p= 0.60). The median time from injury to clinically-confirmed healing was similar between the two groups (47 vs 60.5 days; p=0.54), as was the overall patient satisfaction (Table 2) on the SPAS (median score = 26 [range = 19-28] vs 24 [range 9-28]; p = 0.11). In addition, the patient reported outcomes did not differ significantly between the two groups for the DASH (median score=0 [range= 0-11] vs. 0 [range= 0-43], p= 0.47), or the FAAM (median score= 0 [range= 0-47] vs. 0 [range= 0-0], p= 0.36). A greater proportion of patients that were treated by sports medicine primary care physicians reported they would prefer to see a sports medicine primary care physician for future care relative to the pediatric sports medicine surgeon group (Table 3; 74% vs. 20%; p& 0.001). In contrast, those seen by a sports medicine surgeon or PA indicated they would prefer to see a pediatric PA or pediatric nurse practitioner in the future relative to the pediatric sports medicine primary care group (28% vs. 2%; p= 0.001). Conclusion/Significance: Pediatric primary care sports medicine physicians and pediatric sports medicine orthopedic surgeons, with their PAs, have similar outcomes when caring for young patients with fractures of the radius/ulna and tibia/fibula. Patients report equal satisfaction with their care. Patients will likely have favorable outcomes when they are cared for by any of these providers. Tables and Figures: Table 3. Parent reported preference for future care Future preference for provider Pediatric sports medicine physician Pediatric sports medicine surgeon/PA P value Pediatric sports medicine surgeon 7 (12%) 7 (28%) 0.11 Pediatric sports medicine primary care 43 (74%) 5 (20%) & 0.001 Pediatric physician’s assistant or Pediatric nurse practitioner 1 (2%) 7 (28%) 0.001 Pediatric general orthopedic surgeon 3 (5%) 2 (8%) 0.64 No preference 16 (28%) 9 (36%) 0.45