O3255: Delays in Pediatric Supracondylar Humerus Fracture Management: A Comparison of Pre- and Post-pandemic Trends

Background: During the Covid-19 pandemic, many community hospitals closed their pediatric units to make room for adult beds and did not reopen their pediatric units. The purpose of this study is to evaluate the effect of these closures on pediatric supracondylar humerus fracture management.

Methods: A retrospective review was performed of patients seen for an isolated supracondylar humerus fracture at a single tertiary care pediatric hospital. The pre-pandemic group presented from 1/1/2018–6/3/2019, and the post-pandemic group presented from 3/1/2022–8/31/2023. The two groups were directly compared.

Results: 388 patients were included in the pre-pandemic group and 413 patients in the post-pandemic group with a median age of 5.3 years. Of the patients who were not lost to follow-up, those in the post-pandemic group underwent fewer follow-up appointments, median 3 vs. 2 (p=0.0004).
A higher proportion of patients were transferred to our institution from an outside facility in the post-pandemic group (42% vs. 38%) but this was not significant (p=0.195). However, of the patients who presented directly to our ED, there was a significantly higher proportion of patients in the post-pandemic cohort who presented after referral from an urgent care or primary care provider (PCP), or after being evaluated at an outside hospital ED and being told to follow up with an orthopedist outpatient, 51/239 (21.3%) vs. 33/242 (13.6%)(p=0.030) (Table 1).
Of the patients who presented directly to our ED and were admitted, there was significantly longer time to admission (5.7 vs. 4.0 hours, p< 0.0001), time to surgical intervention (14.0 vs. 9.2 hours, p< 0.0001), and total length of stay (22.9 vs. 20.0 hours, p=0.0004) in the post-pandemic group. Similarly, of the patients transferred to our institution and were admitted, there was significantly longer time to surgical intervention (7.4 vs. 5.8 hours, p=0.0029) and total length of stay (20.0 vs. 17.1 hours, p=0.0002) in the post-pandemic group. In the post-pandemic group, patients who presented directly to our ED and did not require surgery had a significantly longer total length of stay (5.0 vs. 3.9 hours, p< 0.0001). Patients transferred to our ED in the post-pandemic group were more likely to require non-operative care, though this did not reach significance (12% vs. 6%, p=0.084) (Table 2).

Conclusion: Since the pandemic, there have been significant delays in receiving definitive care for supracondylar humerus fractures regardless of method of arrival or intervention type. The increase in patients being sent to the ED at tertiary care centers for supracondylar humerus fracture management after being evaluated elsewhere, particularly for non-operative management, is burdening large pediatric orthopedic centers and fueling delays in care.