title: The economic burden of outpatient appointments following paediatric fractures.
abstract: BACKGROUND
  Paediatric fractures are common and frequently followed-up. The aim of this study is to quantify the private costs for the affected families, as well as the costs for society due to paediatric fracture clinic follow-up appointments.
  
  
  METHODS
  295 paired parent and surgeon questionnaire regarding the cost related to a scheduled follow-up appointment for an upper limb fracture in children aged 6-13 years were collected prospectively over 7 months. In addition, the medical appropriateness of the appointment and whether or not the control changed the management of the fracture was investigated.
  
  
  RESULTS
  The direct cost of attending a paediatric upper limb fracture clinic was estimated to €48.5 while the cost for society due to productivity loss was €78.4 per consultation. In 89.2% of the cases the surgeons found the appointment necessary, it was deemed unnecessary or inconclusive in 10.6%. The treatment plan was altered in 6.8%, and an extra follow up was scheduled in 5.8%. Fractures of the clavicle were most often regarded as unnecessary to follow up clinically or radiologically by the surgeons.
  
  
  CONCLUSIONS
  The direct cost for the affected families and the costs for society due to productivity loss of paediatric fracture follow-up appointments are noticeable. Although most patients and surgeons deem these controls as valuable, they lead to a change in treatment plan in only 12.6% of the cases. A stringent management protocol can safely reduce the number of clinical and radiographical follow-ups.
authors.affiliation: Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.
authors.forename: Anne Guro Vreim
authors.initials: AG
authors.lastname: Holm
authors.affiliation: Health Services Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Lurås
authors.affiliation: Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway. Electronic address: pran@ahus.no.
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Randsborg
mesh_terms: D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D017281:Cost of Illness; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000534:rehabilitation; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D010290:Parents / Q000523:psychology; D010372:Pediatrics / Q000191:economics*; D011446:Prospective Studies; D011859:Radiography / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data
keywords: Follow-up; Fracture management; Paediatric fractures; Socioeconomic costs; Upper limb