title: Incidence of skin complications and associated charges in children treated with hip spica casts for femur fractures.
abstract: BACKGROUND
  Spica cast immobilization remains the treatment of choice for femur fractures in children aged 6 months to 6 years. The incidence of skin complications and their associated charges have not been well described. This study's purposes were to: (1) determine the rate of skin complications in children treated with spica casts for femur fractures, (2) identify predictors, and (3) calculate the charges associated with skin complications.
  
  
  METHODS
  Health records for all patients treated with immediate spica casting for a femur fracture at a major tertiary-care children's hospital from 2003 to 2009 were reviewed and relevant data were abstracted. Descriptive statistics and univariate and multiple logistic regression analyses were used to compare children with and without skin complications and to identify predictors of skin complications. The total charges for skin complications leading to a cast change and early bivalving and lining were calculated.
  
  
  RESULTS
  Of the 300 spica cast applications in 297 patients, 77 subjects (28%) had skin complications. Twenty-four (31%) of these 77 patients underwent a cast change in the operating room, 34 (44%) required early bivalving and lining and 19 (25%) required cast trimming and/or skin care. Predictors of skin complications included: child abuse as mechanism of injury, younger age, and cast time more than 40 days. Sex, weight, fracture location, and total number of clinic visits were not statistically significant predictors of skin complications. The median charge for patients who required cast changes for skin complications was $12,719 ($8632 to $53,768), whereas the median charge for bivalving and lining was $416.51 ($403.32 to $449.00).
  
  
  CONCLUSIONS
  Spica cast treatment is associated with numerous skin complications and additional charges. Victims of child abuse may benefit from additional clinical oversight. Future research needs to investigate patient education and casting interventions that reduce skin complications.
  
  
  METHODS
  Prognostic Level III-case-control study with patient identified based on outcome-skin complications versus no skin complications.
authors.affiliation: Department of Orthopaedics, Children's Hospital, Boston, MA 02115, USA. Rachel.difazio@childrens.harvard.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: DiFazio
authors.forename: Judith
authors.initials: J
authors.lastname: Vessey
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Michael Timothy
authors.initials: MT
authors.lastname: Hresko
authors.forename: Travis
authors.initials: T
authors.lastname: Matheney
mesh_terms: D000367:Age Factors; D002370:Casts, Surgical / Q000009:adverse effects* / Q000191:economics; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000191:economics / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012871:Skin Diseases / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors