Abstract
Background
Pediatric hand fractures are common, yet disparities in their management and outcomes remain underexplored. The purpose of this study is to investigate the influence of socioeconomic status (SES) and health insurance status on time-to-presentation, treatment, and outcomes for pediatric hand fractures.Methods
We conducted a retrospective cohort study of pediatric patients who presented with hand fractures between January 2021 and December 2022, identified through electronic health records. Patient demographics, date of presentation, treatment (operative vs non-operative), and outcomes were assessed. Multivariable regression analyses were used to evaluate delayed presentation (>8 days from the initial injury, defined as 75th percentile of days to presentation) and need for operative intervention based on sociodemographics, Child Opportunity Index (COI) level (a proxy for SES), and fracture characteristics.Results
We included 300 patients (median age: 14 years [interquartile range: 13-16]; 76.7% male). Of these, 63 patients (21.0%) experienced delayed presentation, and 38 patients (12.7%) underwent operative intervention. forty-fiveIn total 145, patients (48.3%) had private insurance and 155 (51.7%) had public insurance. The multivariable analysis showed no statistically significant differences in delayed presentation based on sex, race, primary language, or type of insurance. However, patients living in neighborhoods with very low to moderate COI were found to have a significant delay in time to presentation compared to those with high to very high COI.Conclusions
In this retrospective cohort of pediatric patients with hand fractures, those with lower COI were more likely to experience delayed presentation. No significant differences in time to presentation and intervention type (operative vs non-operative) were observed based on sex, insurance type, primary language, or race/ethnicity. These findings underscore the importance of socioeconomic measures such as COI as separate from race and ethnicity data and highlight the need for focused interventions to ensure equitable care for all pediatric patients.Key concepts
(1)Pediatric patients from low or very low Child Opportunity Index scores are more likely to have a delayed presentation after finger and hand fractures.(2)The observed difference is independent of race, ethnicity, language, and insurance.(3)Care pathways are needed to improve access for these underserved patients with acute injuries.Level of evidence
IV, Case series.