title: Pediatric fractures: temporal trends and cost implications of treatment under general anesthesia.
abstract: OBJECTIVE
  Pediatric fractures are common and are often managed by manipulation under general anesthesia (MUA). This study's aim was to assess the changing pattern of pediatric fractures over 6 years and use this data to perform a workload forecast and estimate cost implications of treatment under general anesthesia.
  
  
  METHODS
  The Emergency Department (ED), operating theater and ward admissions data of children aged 1-11 years presenting with fractures was analyzed. We calculated caseload trends, delay to operation, various parameters of service provision, and the current cost of treating each fracture. We then performed predictive cost analysis for the next 3 years to estimate potential savings by manipulating fractures in ED under ketamine sedation.
  
  
  RESULTS
  The case load has increased >350% in 6 years (total fractures increasing at 23% and MUAs increasing at 17% per year, respectively). The summer months and evenings have been consistently busier. 72% of fractures were managed by pure reduction alone (MUA), 22% by reduction + K-wires, and various other procedures were performed in 1%. The median delays from ED presentation to admission, definitive procedure and discharge were 4, 21 and 33 h, respectively. Each MUA took 52 min and cost the hospital £723. Assuming that the current trends continue, the expenditures would be £101 K, £114 K, and £128 K for 2010, 2011 and 2012, respectively.
  
  
  CONCLUSIONS
  Fracture manipulation in children under general anesthesia often requires an overnight hospital stay, which is not only uncomfortable for the child and inconvenient for the parents but it also increases the burden on the limited National Health Service (NHS) resources. There is a 23% annual increase in fractures and children have to wait for 21 h before the definitive procedure. Using ketamine to manipulate children's fractures in the ED could offer potential service and cost improvements.
authors.affiliation: Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK. gulatiaashish@doctors.org.uk.
authors.forename: A
authors.initials: A
authors.lastname: Gulati
authors.affiliation: Anesthetics and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Dixit
authors.affiliation: Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Taylor
keywords: Cost implications; General anesthesia; Manipulation; Pediatric fractures; Trends
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