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Epidemiology and Health Disparities of Treating Pediatric Finger Amputation Injuries in the United States
Lee Squitieri, BS, Heidi Reichert, MA, Justin A. Steggerda, BA, H. Myra Kim, ScD, Kevin C. Chung, MD, MS.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Despite the common practice of digital replantation in children, little is known about the epidemiology and distribution of care for pediatric finger amputation injuries in the United States. National studies for common surgical procedures have shown health care disparities on the basis of race, insurance status, and income. The current shortage of hand surgeons covering emergency rooms raises concerns regarding children’s access to replantation surgery in certain geographic regions. We determined the prevalence of surgically managed pediatric finger amputation injures in the United States and evaluated factors associated with increased or decreased likelihood of receiving replantation.
METHODS: Over 21 million weighted discharge records from the 2000, 2003, and 2006 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) were screened to identify discharge records with the following ICD-9 procedure codes: 84.21 (thumb reattachment); 84.22 (finger reattachment); 84.01 (amputation and disarticulation of finger); and 84.02 (amputation and disarticulation of thumb). The HCUP KID is the only all-payer national inpatient care database for children in the United States. National estimates for single digit and multiple digit injuries were generated using weighted frequency calculations. Logistic regression models, adjusting for age, transfer status, income, injury severity, and digit type were used to examine the influence of various demographic factors on treatment.
RESULTS: 1,321 weighted discharge records (1,089 single digit, 232 multiple digits) satisfied our inclusion criteria. From 2000-2006, the rate of attempted replantation for pediatric finger amputation injuries has remained relatively stable at approximately 40%. The majority of injuries were treated at non-children’s (86%) and non-teaching (76%) hospitals. 52% of digit replantations were performed at hospitals with a volume of 1-2 digit replantations per year. We found that blacks (OR = 0.47), hispanics (OR = 0.38), and children without insurance (OR = 0.36) were less likely to receive attempted replantation (all p < 0.05), even after controlling for potentially confounding factors, such as age, gender, family income, transfer status, geographic location, hospital type, digit type, injury severity, and mechanism of injury.
CONCLUSION: Finger replantation is a technically challenging operation that demands regionalization of this specialized service. However, this analysis raises grave concern that the majority of the replantation cases for the US pediatric population were performed by low-volume hospitals that are not designated as children’s hospitals. Furthermore, we found that children in the minority population without insurance are less likely to receive digital replantation, which confirm the findings of other studies regarding the lack of access to care because of health disparities.
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