title: Utility of the AAOS Appropriate Use Criteria (AUC) for Pediatric Supracondylar Humerus Fractures in Clinical Practice.
abstract: BACKGROUND
  The American Academy of Orthopaedic Surgeons (AAOS) recently developed an Appropriate Use Criteria (AUC) for pediatric supracondylar humerus fractures (PSHF). The AUC is intended to improve quality of care by informing surgeon decision making. The aim of our study was to cross-reference the management of operatively treated PSHF with the AAOS-published AUC.
  
  
  METHODS
  The AUC for PSHF include 220 patient scenarios, based on different combinations of 6 factors. For each patient scenario, 8 treatment options are evaluated as "appropriate," "maybe appropriate," and "rarely appropriate." We retrospectively reviewed the medical charts and radiographs of all operatively treated PSHF at our hospital from January 2013 to December 2014 and determined the appropriateness of the treatment.
  
  
  RESULTS
  Over the study period, 94 children (mean age: 5.2 y; 51 male, 43 female) were admitted with PSHF and underwent a surgical procedure (type IIA: 7, type IIB: 14, type III: 70, flexion type: 3). Only 8 of the 220 scenarios were observed in our patient cohort. The most frequent scenario was represented by a type III fracture, palpable distal pulse, no nerve injury, closed soft-tissue envelope, no radius/ulna fracture, and typical swelling. Of the 94 fractures, the AUC was "appropriate" for 84 cases and "maybe appropriate" for 9 cases. There was only 1 case of "rarely appropriate" management. Closed reduction with lateral pinning and immobilization was the most prevalent treatment option (58.5%). The rate of appropriateness was not affected by the operating surgeon. However, the definition of a case as emergent had a significant impact on the rate of appropriateness.
  
  
  CONCLUSIONS
  Application of the AUC to actual clinical data was relatively simple. The majority of operatively treated PSHF (89.4%) were managed appropriately. With the introduction of electronic medical charts, an AUC application becomes attractive and easy for orthopaedic surgeons to utilize in clinical practice. However, validity studies of the AUC in different clinical settings are still required.
  
  
  METHODS
  Level IV.
authors.affiliation: *Department of Surgery, Section of Orthopedics, Hamad General Hospital, Doha, Qatar †Department of Healthcare Policy and Research, Weill Cornell Medical College ‡Healthcare Research Institute, Hospital for Special Surgery, New York, NY.
authors.forename: Talal
authors.initials: T
authors.lastname: Ibrahim
authors.forename: Abdelsalam
authors.initials: A
authors.lastname: Hegazy
authors.forename: Safa I S
authors.initials: SI
authors.lastname: Abulhail
authors.forename: Hassan M K
authors.initials: HM
authors.lastname: Ghomrawi
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D000070628:Closed Fracture Reduction / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000601:surgery*; D007103:Immobilization / Q000379:methods; D007223:Infant; D008297:Male; D000070799:Open Fracture Reduction / Q000379:methods*; D011787:Quality of Health Care; D011859:Radiography; D011885:Radius Fractures / Q000150:complications / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014458:Ulna Fractures / Q000150:complications / Q000601:surgery