Thurs., 10/8/09 Pediatrics & Injury Prevention, Paper #27, 2:52 pm OTA-2009
On-Call Coverage for Pediatric Orthopaedic Emergencies: Description of an Effective Call System to Optimize Pediatric Patient Care
Christopher Bray, MD1 (n); Brian Scannell, MD1 (n);
Michael J. Bosse, MD1 (5-KCI, Medtronic; 7-OREF, Synthes, Zimmer); Steven Frick, MD1 (n);
Virginia Casey, MD2 (n); D. Christian Clark, MD2 (n); J. Michael Wattenbarger, MD2 (n);
1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA;
2OrthoCarolina, Charlotte, North Carolina, USA
Purpose: Pediatric orthopaedic emergencies can play a significant role in the responsibilities of the on-call orthopaedist, especially in institutions that see high volumes of pediatric patients. Growing medicolegal and workforce concerns in orthopaedics have created a shift in the care of pediatric fractures and infections from general orthopaedists and traumatologists to fellowship-trained pediatric orthopaedists. With the small numbers of current pediatric orthopaedists, however, a solution to on-call coverage for the pediatric orthopaedic patient is needed. This study describes our current call system involving adult subspecialists (including traumatologists) and pediatric orthopaedists at a Level 1 trauma center, and defines the emergent pediatric surgical case load of the adult subspecialists.
Methods: All operative pediatric orthopaedic trauma and emergent cases done on call (after 5:00 pm and on weekends) at our institution during 2008 were retrospectively reviewed from our surgical database. These included infections and soft-tissue injuries, compartment syndrome, slipped capital femoral epiphyses (SCFE), and fractures. Nonemergent cases were delayed until the following day to be cared for by a pediatric subspecialist. For each emergent case, the attending physician’s subspecialty, diagnosis, procedure, and any revisions during the hospitalization by the pediatric subspecialist were recorded.
Results: There were 216 pediatric cases done on call by 13 attending physicians (4 pediatric, 4 traumatology, 2 foot and ankle, 2 oncology, 1 shoulder and elbow) during 2008. These included infections or soft-tissue injuries (n = 56), compartment syndrome (n = 2), SCFE (n=12), and fractures of the extremities (n = 146). 92 of these cases were performed by the covering adult subspecialty orthopaedic surgeon. Diagnoses cared for by adult subspecialists included: 31 femur fractures, 24 infection/soft-tissue injuries, 22 humerus/elbow fractures, 4 tibia fractures, 3 hip fractures, 2 compartment syndromes, 2 foot fractures, 2 radius fractures, 1 ulna fracture, and 1 ankle fracture. Only 1 case performed by an adult orthopaedist was revised (~1%).
Conclusions: Our current call system is an effective way to lessen the call burden on pediatric orthopaedic surgeons, while optimizing care for the pediatric patient. Adult subspecialists can effectively and safely share the call pool, take care of emergent pediatric cases on call, and efficiently dispose of pediatric urgencies to a pediatric orthopaedist the following day at a Level 1 institution. Adult subspecialists taking pediatric call should be prepared to provide emergent surgical care for fractures, infections, soft-tissue injuries, and compartment syndrome.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant