Emergency Pediatric Orthopaedic Transfer Criteria: A Pilot Study.

The purpose of this study was to define pediatric orthopaedic transfer criteria for patients coming from a smaller facility to a Level I pediatric trauma center. A 10-question phone survey was utilized for every transfer request. Fifty-eight transfer requests were prospectively collected and retrospectively reviewed. The criteria were based on The American Academy of Pediatrics (AAP) guidelines and the expert opinion of the senior author. The AAP criteria included complex fractures/dislocations and bone and joint infections. The expert opinion criteria included a patient requiring admission to the hospital or a patient needing surgery. All centers requesting transfers were staffed by an on-call board-certified general orthopaedic surgeon with the ability to care for pediatric orthopaedic injuries. Of the 58 transfers, 37 (64%) did not meet transfer criteria; 21 (36%) met transfer criteria. Transfer requests came from Emergency Department (ED) physicians in 25/58 cases (43%), physician assistants in 11/58 (19%), orthopaedic attending physicians in 3/58 (5%), and orthopaedic residents in 3/58 (5%). The orthopaedic surgeon at the referring hospital examined the patient in only six instances (10%) prior to transfer. Of the 58 patients, 18 (31%) required a hospital admission, and 17 (29%) patients were indicated for surgery. In the current study, 64% of pediatric orthopaedic transfers did not meet criteria for an inter-facility hospital to hospital transfer and were potentially avoidable. (Journal of Surgical Orthopaedic Advances 32(3):182-186, 2023).

Rate of orthopedic resident and medical student recognition of nonaccidental trauma: a pilot study.

The purpose of this study was to evaluate the efficacy and accuracy of mandated reporters to identify child abuse in children presenting with fractures. An Institutional Review Board approved survey-based study between January 2017 and December 2017 was conducted at a tertiary care academic medical center. 10 cases were combined to create one survey. Each case had information on presentation history, radiographic data, and social history. This study assesses the ability of 13 orthopedic residents and 11 medical students to diagnose child abuse. Participants had the option to explain their reasoning for a given case. To evaluate decision-making reasoning, we split responses into three cohorts, encompassing objective evidence, subjective evidence, or social evidence. Twenty-four participants completed the survey; 203 out of 240 (85%) included the rationale for the diagnosis of child abuse. The observed diagnostic odds ratio was 0.83 for medical students, 0.93 for junior residents, and 0.96 for senior residents. There was no statistically significant difference in diagnosing child abuse between a participant's level of experience, age, or whether participants had their own children. Participants who used more than one source of evidence were significantly more likely to make the correct diagnosis (P = 0.013). Participant decisions were no more accurate than a coin toss. The use of several data sources led to increased diagnostic accuracy. There is low accuracy in correctly diagnosing child abuse in our cohort of mandated reporters. Participants who highlighted using several sources of evidence were more likely to diagnose child abuse accurately.