Disparities in follow-up care for ballistic and non-ballistic long bone lower extremity fractures |
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| Affiliation: | 1. Emory University School of Medicine, Department of Medicine, United States;2. Emory University School of Medicine, Department of Orthopaedics, United States;3. Medical College of Georgia, United States;1. University of Minnesota Department of Surgery, Minneapolis, MN 55455 United States;2. University of Virginia Department of Surgery, Charlottesville, VA 22903 United States;3. Western Michigan University School of Medicine, Department of Surgery, Kalamazoo, MI 49008 United States;1. Chief Orthopedic Trauma Group, Instituto de Ortopedia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;2. Hansjörg Wyss AO Medical Foundation Chair of Orthopaedic Trauma, University of Mississippi Medical Center, Jackson, MS, USA;3. Head division of Orthopedics, King Abdulaziz Medical City, Al-Madinah, Saudi Arabia,;4. Head Medical Affairs and Health Economics, AO Foundation, Clinical Investigation and Documentation (AOCID), Switzerland;5. Senior Project Manager Curriculum Development, AO Foundation, AO Education Institute, Stettbachstrasse 6, 8600, Duebendorf, Switzerland;6. Director of Research, ASSERT Centre, College of Medicine and Health, University College Cork, Ireland;1. Undergraduate Medical Education Program, Queen’s University, Kingston, ON, Canada;2. Postgraduate Medical Education Program, Queen’s University, Kingston, ON, Canada;3. Department of Surgery, Queen’s University, Kingston, ON, Canada |
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| Abstract: | ObjectivesTo describe differences in follow-up compliance and emergency department (ED) visits between ballistic and non-ballistic operative lower extremity fracture patients.DesignRetrospective study.SettingUrban level 1 trauma center.Patients/ParticipantsPatients age ≥18 years with ≥1 tibia or femur fractures treated with ORIF or intramedullary nailing (IMN) between September 1, 2013 and August 31, 2015.Main Outcome MeasureA compliance fraction calculated as ([number of attended follow-up visits] / [number of attended follow-up visits + number of missed follow-up visits]) and ED visits in the post-operative period.Results612 patients were studied. Patients with ballistic lower extremity fractures had a younger mean age (30.8 years v. 41.6 years; p < 0.0001); a shorter length of stay (5.00 days v. 8.00 days; p < 0.0001); and were more likely to be male (92.6% v. 68%; p < 0.0001) and African-American (90.1% v. 63.1%; p < 0.0001) when compared to non-ballistic long bone injuries. Increased follow-up compliance (defined as a compliance fraction ≥0.75) was associated with having a non-ballistic fracture (OR 1.73, 1.13–2.64; p = 0.01), not having an ED visit (OR 2.08, 1.30–3.33; p = 0.002), and being female (OR 1.82, 1.27–2.61; p = 0.001). Increased ED utilization (≥ 1 ED visit) was associated with ballistic mechanism (OR 1.95, 1.20–3.16; p = 0.006), a low follow-up compliance fraction (OR 2.08, 1.30–3.33; p = 0.0019), homelessness (OR 3.91, 1.53–9.98; p = 0.006), and African-American race (OR 2.26, 1.26–4.05; p = 0.05). Scheduling a specific follow-up visit on the discharge summary did not predict higher compliance (OR 1.51, 0.98–2.33; p = 0.06). Conversely, the lack of a specific follow-up visit scheduled on the discharge summary did not predict ED utilization (OR 0.63, 0.34–1.17; p = 0.14).ConclusionThe results of this study demonstrate that increased utilization of the ED was associated with ballistic fractures, homelessness, decreased clinic compliance, and African American race. Furthermore, patients with non-ballistic injuries, women, and those without any ED visit were more likely to have higher outpatient clinic compliance. |
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| Keywords: | Compliance Follow-up Ballistic fracture Femur fracture Tibia fracture |
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