Medial Epicondyle Fractures in Children and Adolescents: Shifting Care from General Hospitals to Children's Hospitals?
OBJECTIVE
To determine if there is a shift in the treatment of children with medial epicondyle fractures toward children's hospitals, and to explore potential confounders of any observed effect.


METHODS
The Healthcare Cost and Utilization Project Kids' Inpatient Database was used to examine the epidemiology of medial epicondyle fractures, particularly with attention to whether they were admitted to a general hospital or a children's hospital (defined as free-standing children's hospitals, specialty children's hospitals, and children's units within general hospitals). Age and insurance payer status were also collected and evaluated as potential confounders.


RESULTS
The proportion of medial epicondyle hospital discharges from children's hospitals increased (from 29%-46%; P < .001), and the proportion of discharges from general hospitals declined over the study period (from 71%-42%; P < .001). Age and insurance payer status both remained consistent throughout the study period and did not contribute to this finding.


CONCLUSIONS
This study demonstrates an increase in the proportion of discharges for pediatric medial epicondyle fractures from children's hospitals. Although this finding is likely multifactorial, it may represent increasing subspecialization and increasing medical liability when treating children. Children's hospitals should identify those conditions which will continue to increase in number and consider constructing clinical pathways in order to optimize delivery of care and resource utilization.
Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: fabricantp@email.chop.edu.
Peter D
PD
Fabricant
Children's Hospital of Philadelphia, Philadelphia, PA.
Mark A
MA
Seeley
Hospital of the University of Pennsylvania, Philadelphia, PA.
Jason B
JB
Anari
Children's Hospital of Philadelphia, Philadelphia, PA.
Theodore J
TJ
Ganley
Children's Hospital of Philadelphia, Philadelphia, PA.
John M
JM
Flynn
Children's Hospital of Philadelphia, Philadelphia, PA.
Keith D
KD
Baldwin
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017722:Hospital Charges / Q000639:trends*; D006760:Hospitalization / Q000191:economics*; D006769:Hospitals, General / Q000191:economics*; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D006810:Humeral Fractures / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D015994:Incidence; D007223:Infant; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D008297:Male; D010351:Patient Discharge / Q000191:economics; D010414:Pennsylvania / Q000453:epidemiology; D055815:Young Adult