{"pk":12566,"title":"Concurrent Proximal Fractures Are Rare in Distal Forearm Fractures: A National Cross-sectional Study","subtitle":null,"abstract":"Introduction:\n Distal forearm fractures (DFF) account for 1.5% of emergency department (ED) visits in the United States. Clinicians frequently obtain imaging above/below the location of injury to rule out additional injuries. We sought to determine the incidence of associated proximal fractures (APF) in the setting of DFF and to evaluate the imaging practices in a nationally representative sample of EDs.\nMethods:\n We queried the 2013 National Emergency Department Sample  using International Classification of Diseases, 9th edition, diagnostic codes for DFF and APF. Current Procedural Technology codes identified associated imaging studies. We calculated national estimates using a weighted analysis of patient and hospital-level characteristics associated with APF and imaging practices. An analysis of costs estimated the financial impact of additional imaging in patients with DFF using Medicare reimbursement to approximate costs according to the 2018 Medicare Physician Fee Schedule.\nResults: \nIn 2013, an estimated 297,755 ED visits (weighted) were associated with a DFF, of which 1.6% (4836 cases) had an APF. The incidence of APF was lower among females (odds ratio [OR] (0.76); 95% confidence interval [CI], 0.64-0.91) but higher in metropolitan teaching hospitals compared to metropolitan non-teaching hospitals (OR [2.39]; 95% CI, 1.43-3.99) and Level 1 trauma centers (OR [3.9]; 95%, 1.91-7.96) compared to non-trauma centers. Approximately 40% (n = 117,948) of those with only DFF received non-wrist radiographs and 19% (n = 55,236) underwent non-wrist/non-forearm imaging. Factors independently associated with additional imaging included gender, payer, patient and hospital rurality, hospital region, teaching status, ownership, and trauma center level. Nearly $3.6 million (2018 U.S. dollars) was spent on the aforementioned additional imaging.\nConclusion:\n Despite the frequency of proximal imaging in patients with DFF, the incidence of APF was low. Further study to identify risk factors for APF based on mechanism and physical examination factors may result in reduced imaging and decreased avoidable healthcare spending.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Forearm fractures, trauma, epidemiology of fractures"}],"section":"Trauma","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8376q6f9","frozenauthors":[{"first_name":"Matthew","middle_name":"","last_name":"Negaard","name_suffix":"","institution":"University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa","department":"None"},{"first_name":"Priyanka","middle_name":"","last_name":"Vakkalanka","name_suffix":"","institution":"University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa\n\nUniversity of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa","department":"None"},{"first_name":"M","middle_name":"Terese","last_name":"Whipple","name_suffix":"","institution":"Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Christopher","middle_name":"","last_name":"Hogrefe","name_suffix":"","institution":"Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois\n\nNorthwestern Medicine and Northwestern University Feinberg School of Medicine, Department of Medicine and Orthopedic Surgery, Chicago, Illinois","department":"None"},{"first_name":"Morgan","middle_name":"B","last_name":"Swanson","name_suffix":"","institution":"University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa\n\nUniversity of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa","department":"None"},{"first_name":"Karisa","middle_name":"K","last_name":"Harland","name_suffix":"","institution":"University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa\n\nUniversity of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa","department":"None"},{"first_name":"Ross","middle_name":"","last_name":"Mathiasen","name_suffix":"","institution":"University of Nebraska Medical Center, Department of Emergency Medicine, Omaha, Nebraska","department":"None"},{"first_name":"Jon","middle_name":"","last_name":"Van Heukelom","name_suffix":"","institution":"University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa","department":"None"},{"first_name":"Timothy","middle_name":"W","last_name":"Thomsen","name_suffix":"","institution":"University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa\n\nUniveristy of Iowa Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, Iowa","department":"None"},{"first_name":"Nicholas","middle_name":"M","last_name":"Mohr","name_suffix":"","institution":"University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa\n\nUniversity of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa\n\nUniversity of Iowa Carver College of Medicine, Department of Anesthesia, Division of Critical Care, Iowa City, Iowa","department":"None"}],"date_submitted":"2019-03-04T10:55:24+11:00","date_accepted":"2019-03-04T10:55:24+11:00","date_published":"2019-08-27T06:00:34+10:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12566/galley/6661/download/"}]}