脑瘫儿童骨折与短期不良健康后果之间的关联。

IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Bone Pub Date : 2024-10-02 DOI:10.1016/j.bone.2024.117267
Daniel G. Whitney , Noelle S.B. Whyte , Michelle S. Caird
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引用次数: 0

摘要

背景:脑瘫(CP)儿童骨折的风险很高;然而,人们对他们骨折后的健康状况却知之甚少。骨折是一种计划外事件,而手术或程序则有一个优化身体成分和健康的术前阶段以及有计划的术后随访护理。由于骨折的不可计划性和反应性护理,骨折可能会导致严重后果。本研究旨在确定骨折是否与 CP 儿童短期不良健康后果发生率的增加有关,以及这些关联是否与年龄有关:这项回顾性队列研究使用的是 2001 年 1 月 1 日至 2001 年 12 月 31 日期间的商业索赔。主要队列是 2-18 岁患有心绞痛并发生骨折(心绞痛 + 骨折)的儿童。对比队列在人口统计学和健康相关指标上与 CP + Fx 按 1:1 进行倾向评分匹配:无骨折的 CP(CPw/oFx);无骨折的 CP(w/oCP + Fx)或无骨折的 CP(w/oCPw/oFx)。对 30 天和 31-90 天肺炎发病率(IR)和 90 天急诊就诊率(IRR)进行了估算。Cox回归检验了年龄和性别对影响的修饰作用:CP + Fx队列(n = 1670)的30天肺炎(IRR范围为1.53-4.54)和90天急诊就诊(IRR范围为1.45-2.37)的IRR较高(均为P 0.05)。值得注意的是,有证据表明年龄会影响效果。与 CPw/oFx 相比,年龄越大,CP + Fx 的 30 天肺炎发病率越高,90 天 ED 就诊率也越高。与CP/OFX相比,CP+Fx的90天急诊就诊率在年龄越小时问题越严重:结论:CP 儿童骨折与短期肺炎和急诊室就诊率增加有关,年龄越大,问题越严重。
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The association between fracture and short-term adverse health outcomes among children with cerebral palsy

Background

Children with cerebral palsy (CP) have a high risk of fracture; yet, little is known about their post-fracture health outcomes. A fracture is an unplanned event in contrast to surgeries or procedures where there is a pre-operative period to optimize body composition and health and planned post-operative follow-up care. Fractures may be associated with significant outcomes due to the unplannable nature and reactionary care. The objective of this study was to determine if fractures were associated with an increased rate of short-term adverse health outcomes among children with CP, and if these associations were dependent on age.

Methods

This retrospective cohort study used commercial claims from 01/01/2001–12/31/2018. The primary cohort was children 2–18 years old with CP and an incident fracture (CP + Fx). Comparison cohorts were propensity score matched 1:1 to CP + Fx on demographic and health-related indicators: CP without fractures (CPw/oFx); without CP with (w/oCP + Fx) or without (w/oCPw/oFx) a fracture. The incidence rate (IR) and IR ratios (IRR) of 30-day and 31–90-day pneumonia and 90-day emergency department (ED) visit were estimated. Cox regression tested for effect modification by age and sex.

Results

The CP + Fx cohort (n = 1670) had higher IRs of 30-day pneumonia (IRR range, 1.53–4.54) and 90-day ED visit (IRR range, 1.45–2.37) (all P < 0.05), and higher IRs of 31–90-day pneumonia but this did not reach statistical significance (IRR, 1.41 to 2.32, all P > 0.05). Notably, there was evidence of effect modification by age. The rate of 30-day pneumonia became more problematic for CP + Fx with older age relative to comparison cohorts and for 90-day ED visit compared to CPw/oFx. The rate of 90-day ED visit for CP + Fx was more problematic at younger ages compared to w/oCP + Fx.

Conclusions

Fractures among children with CP were associated with an increased rate of short-term pneumonia and ED visit, which was more problematic with older age.
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来源期刊
Bone
Bone 医学-内分泌学与代谢
CiteScore
8.90
自引率
4.90%
发文量
264
审稿时长
30 days
期刊介绍: BONE is an interdisciplinary forum for the rapid publication of original articles and reviews on basic, translational, and clinical aspects of bone and mineral metabolism. The Journal also encourages submissions related to interactions of bone with other organ systems, including cartilage, endocrine, muscle, fat, neural, vascular, gastrointestinal, hematopoietic, and immune systems. Particular attention is placed on the application of experimental studies to clinical practice.
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