Volume VIII, Number 1 | Spring 2024

Social Deprivation and the Preoperative Experience in Pediatric Femur Fractures

1Zimmerman R, 2Woodall B, 1Kim C, 1Schlechter J
1CHOC, Orange, California, USA; 2Riverside University Health System – Moreno Valley, Moreno Valley, CA, 92555

The associations between socioeconomic status and health disparities have been an ongoing topic of research. Past research has shown lower socioeconomic status can lead to increased fracture risk, slower fracture healing, and discrepancies in analgesia prescription. This study examines the relationship between a patient’s area deprivation index (ADI) as a measure of socioeconomic status, to opioid consumption and time to surgery in pediatric femur shaft fractures.

This is an IRB-approved retrospective chart review of pediatric patients 17 years or younger at a level 1 pediatric trauma center, who underwent femoral intramedullary fixation for a primary femur fracture in 2020-2022. Demographics, as well as emergency room and perioperative medical records were reviewed. State-relative ADI was calculated with a standardized neighborhood atlas, with values ranging from 1-10. Patients were divided into two cohorts: ADIs of 1-5 (least disparate, LD) and 6-10 (most disparate, MD). Statistical analysis was accomplished via Mann-Whitney U, ANOVA, and Chi-Square Tests.

Forty-four patients were included with a mean age of 11.3 years (5-17 years). There were 27 and 17 patients in the (LD) and (MD) cohorts, respectively. Time to surgery and preoperative opioid consumption was significantly different between groups. The least disparate group took 10.8 hours versus the most disparate group took 15.7 hours to reach surgery. On average per patient, the least disparate group consumed 8.9 morphine milliequivalents (MME), while the most disparate group consumed 16.2 MME. No significant differences in age, sex, and weight existed. There was a higher proportion of Hispanic/Latinx in the MD cohort. More patients had private insurance in the LD cohort, while the MD cohort had higher amounts of government insurance. However, insurance type was not associated with any difference of preoperative effects upon analysis.

This study supports an association between socioeconomic status and increased MME consumption and time to surgery in pediatric femur fractures. This study draws attention to the disparities experienced by pediatric patients.


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  3. Ortega HW, Velden HV, Truong W, Arms JL. Socioeconomic Status and Analgesia Provision at Discharge Among Children With Long-Bone Fractures Requiring Emergency Care. Pediatr Emerg Care. 2021 Sep 1;37(9):456-461.
The Journal of the American Osteopathic Academy of Orthopedics

Steven J. Heithoff, DO, FAOAO

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