Delays in Pediatric Supracondylar Humerus Fracture Management: A Comparison of Pre- and Postpandemic Trends

BACKGROUND: The purpose of this study is to compare patient presentation characteristics and timeliness of pediatric supracondylar humerus fracture management from before and after the COVID-19 pandemic. These comparisons may lead to the identification of changes in emergency department (ED) flow or operating room availability since the pandemic. METHODS: A retrospective review was done of patients seen for an isolated supracondylar humerus fracture at a single tertiary care pediatric hospital. The prepandemic group presented from January 1, 2018 to June 30, 2019, and the postpandemic group presented from March 1, 2022 to August 31, 2023. The two groups were directly compared. RESULTS: Three hundred eighty-eight patients were included in the prepandemic group, and 413 patients in the postpandemic group with a median age of 5.3 years. Of the patients who presented directly to our ED and were admitted, there was markedly longer time to admission (5.7 vs. 4.0 hours; P < 0.0001), time to surgical intervention (14.0 vs. 9.2 hours; P < 0.0001), and total length of stay (22.9 vs. 20.0 hours; P = 0.0004) in the postpandemic group. Similarly, of the patients who were transferred to our institution and were admitted, there was markedly longer time to surgical intervention (7.4 vs. 5.8 hours; P = 0.0029) and total length of stay (20.0 vs. 17.1 hours; P = 0.0002) in the postpandemic group. In the postpandemic group, patients who presented directly to our ED and did not require surgery had a markedly longer total length of stay (5.0 vs. 3.9 hours; P < 0.0001). Patients transferred to our ED in the postpandemic group were more likely to require nonsurgical care, although this did not reach significance (12% vs. 6%; P = 0.084). CONCLUSION: Since the pandemic, there have been notable delays in care for pediatric supracondylar humerus fractures. Identification of these delays provides support for the restructuring of hospital resources to help improve the patient experience and physician morale and decrease hospital costs. LEVEL OF EVIDENCE: III.