An estimated 956 children and adolescents experienced traumatic
amputation-associated hospitalizations in 2003, resulting in 3,967 days —
and $21.6 million — lost to hospitalization, according to new study
conducted by researchers at the Center for Injury Research and Policy in The
Research Institute at Nationwide Children’s Hospital in Columbus, Ohio.
Boys experienced 74.4% of traumatic amputations, and the most common
cause was lodging a body part in or between objects, Lara McKenzie, PhD,
assistant professor of pediatrics at the Center for Injury Research and Policy
and at the Ohio State University College of Medicine, told O&P
“Despite a lot of people understanding the severity of the
consequences that are associated with traumatic amputations, we know little
about the epidemiology or the health care resource burden of amputation
injuries, and even less is known in the pediatric population,” she said.
The researchers used data from Jan. 1, 2003 to Dec. 31, 2003, obtained
from the Kids’ Inpatient Database (KID), a component of the Healthcare
Cost Utilization Project, maintained by the Agency for Healthcare Research and
Quality. The KID contains hospital discharge information on pediatric treatment
and use of resources from more than 3,000 hospitals — including academic
medical centers and nonfederal, short-term and specialty hospitals — in 36
|An average of $23,157 was charged
for each pediatric traumatic amputation in 2003. Amputations to the leg
resulted in the highest total charges.
|Source: Pediatric Traumatic
Amputations and Hospital Resource Utilization, 2003
McKenzie and her co-authors reviewed the available information for the
total number of children age 17 or younger who were hospitalized for
traumatic amputation. They found 581 actual cases of patients
in this age range with diagnoses matching the criteria, and then applied a
weighting factor to determine the estimated number for the entire country.
Of the cases, male patients experienced a higher hospitalization rate,
with 74% of the traumatic amputations. These patients had an incidence rate
ratio of 2.06 for traumatic amputation-related hospitalizations when compared
with females, McKenzie said.
The most common cause of hospitalization was a child’s body part
being caught in or between objects, which accounted for about 21% of the cases,
she said. The next most common cause of traumatic amputation was powered tools
and other cutting instruments (about 16% of the cases), lawnmowers (almost
14%), and other machinery (more than 13%).
The researchers evaluated the findings even further, pointing out that
the amputated body part differed according to the mechanism of injury or cause.
Lawnmower-related injuries, for example, were responsible for approximately 79%
of the foot or toe amputations, and 94% of the finger or toe amputations
occurred because of those digits being caught in or between objects.
McKenzie noted that the true costs of traumatic amputations are likely
underestimated because of the lack of emergency department data in this data
set. Additionally, the estimates did not include non-covered charges,
professional fees, time lost from school and work by parents and other
caregivers, and other societal costs.
“The next thing that needs to be done is to look at more effective
interventions, and developing, implementing and evaluating those to reduce
these kinds of injuries,” McKenzie said. — by Stephanie Z. Pavlou
Epidemiological data are always welcome in O&P, in part because they
inform expectations concerning the need for expertise in certain areas —
in this case, pediatric prosthetics. For some reason, though, such data are
scarce. These numbers serve as a welcome reminder that the clinical experiences
gained by prosthetics practitioners can often be valuable to researchers
seeking to reduce traumatic amputations. Too often, I think, we tend to focus
exclusively on the outcomes of persons with limb loss and fail to think of ways
to prevent the limb loss in the first place.
— Mark D. Geil, PhD
Associate professor and
director in the Biomechanics Laboratory Department of Kinesiology and Health,
Georgia State University and Practitioner Advisory Council member,
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