Expanding pediatric orthopaedic trauma volume at a pediatric level 1 trauma hospital

Abstract

Background: Trauma continues to be the leading cause of morbidity and mortality among children. There is a perception among pediatric orthopaedists that the volume of pediatric orthopaedic trauma care is increasing. We hypothesized that the change in trauma volume was greater than the local and regional population change.

Methods: This retrospective analysis (1996 to 2006) of our institution's trauma registry analyzed changes in general trauma and orthopaedic trauma admissions, surgical volumes, patient and population demographics, and hospital reimbursement.

Results: For the decade, the local pediatric population increased annually by only 2% to 3%. During that same period, there was an increase in the proportion of patients treated from outside the immediate county, from 13% in 1996 to 28% in 2006. Total general trauma patient admissions increased at an average of 10% per year from 1996 to 2006, whereas total orthopaedic trauma admissions and orthopaedic trauma admissions requiring operative treatment increased by an annual average of 18%. Orthopaedic trauma admissions as a percentage of total trauma admissions steadily increased from 26% in 1996 to 45% in 2006. During 2005 and 2006, an average total of 1216 orthopaedic trauma cases per year were performed generating an average 10,465 work relative value units per year. Between 1996 and 2005, the hospital's gross charges for pediatric orthopaedic trauma increased by an average of 26% annually; however, the percentage of total charges collected decreased from 67% in 1999 to 28% in 2005.

Conclusions: Pediatric orthopaedic trauma at this level 1 trauma center increased dramatically and more rapidly than the local population over the last decade, increasing the demand for physician and hospital resources. Physicians, hospitals, and the communities they serve face financial and logistical problems of providing care for an expanding volume of pediatric orthopaedic trauma patients with decreasing reimbursements, changing referral patterns and a decreasing population of pediatric orthopaedic specialists. Care of the pediatric orthopaedic trauma patient could become a national crisis.

Level of evidence: Economic analysis-level III.