Background:

Previous studies have reported disparities in orthopaedic care resulting from demographic factors, including insurance status. However, the effect of insurance on pediatric tibial spine fractures (TSFs), an uncommon but significant injury, is unknown.

Purpose:

To assess the effect of insurance status on the evaluation and treatment of TSFs in children and adolescents.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

We performed a retrospective cohort study of TSFs treated at 10 institutions between 2000 and 2019. Demographic data were collected, as was information regarding pre-, intra-, and postoperative treatment, with attention to delays in management and differences in care. Surgical and nonsurgical fractures were included, but a separate analysis of surgical patients was performed. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.

Results:

Data were collected on 434 patients (mean ± SD age, 11.7 ± 3.0 years) of which 61.1% had private (commercial) insurance. Magnetic resonance imaging (MRI) was obtained at similar rates for children with public and private insurance (41.4% vs 41.9%, respectively; P≥ .999). However, multivariate analysis revealed that those with MRI performed ≥21 days after injury were 5.3 times more likely to have public insurance (95% CI, 1.3-21.7; P = .02). Of the 434 patients included, 365 required surgery. Similar to the overall cohort, those in the surgical subgroup with MRI ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI, 1.2-19.6; P = .03). Children who underwent surgery ≥21 days after injury were 2.5 times more likely to have public insurance (95% CI, 1.1-6.1; P = .04). However, there were no differences in the nature of the surgery or findings at surgery. Those who were publicly insured were 4.1 times more likely to be immobilized in a cast rather than a brace postoperatively (95% CI, 2.3-7.4; P < .001).

Conclusion:

Children with public insurance and a TSF were more likely to experience delays with MRI and surgical treatment than those with private insurance. However, there were no differences in the nature of the surgery or findings at surgery. Additionally, patients with public insurance were more likely to undergo postoperative casting rather than bracing.

中文翻译：

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保险状况会影响儿童胫骨脊柱骨折的治疗吗？

背景：

以前的研究报告了人口因素导致的骨科护理差异，包括保险状况。然而，保险对小儿胫骨脊柱骨折 (TSF) 的影响尚不清楚，这是一种不常见但严重的损伤。

目的：

评估保险状况对儿童和青少年 TSF 评估和治疗的影响。

学习规划：

横断面研究；证据水平，3。

方法：

我们对 2000 年至 2019 年间在 10 家机构治疗的 TSF 进行了一项回顾性队列研究。收集了人口统计数据，以及有关术前、术中和术后治疗的信息，并注意管理延迟和护理差异。包括手术和非手术骨折，但对手术患者进行了单独分析。单变量分析之后是有目的的多变量回归以调整混杂因素。

结果：

收集了 434 名患者（平均 ± SD 年龄，11.7 ± 3.0 岁）的数据，其中 61.1% 有私人（商业）保险。公共和私人保险儿童的磁共振成像 (MRI) 获得率相似（分别为 41.4% 和 41.9%；P ≥ .999）。然而，多变量分析显示，在受伤后≥21 天进行 MRI 检查的人拥有公共保险的可能性是其 5.3 倍（95% CI，1.3-21.7；P = .02）。在纳入的 434 名患者中，365 名需要手术。与整个队列相似，MRI ≥ 21 天的手术亚组患者拥有公共保险的可能性高 4.8 倍（95% CI，1.2-19.6；P= .03)。受伤后≥21 天接受手术的儿童获得公共保险的可能性是其 2.5 倍（95% CI，1.1-6.1；P = .04）。然而，手术的性质或手术结果没有差异。那些有公共保险的人术后被固定在石膏而不是支架中的可能性要高 4.1 倍（95% CI，2.3-7.4；P < .001）。

结论：

与拥有私人保险的儿童相比，拥有公共保险和 TSF 的儿童更容易出现 MRI 和手术治疗延误。然而，手术的性质或手术结果没有差异。此外，有公共保险的患者更有可能接受术后铸造而不是支撑。