Fracture-related hospitalisations and readmissions of Australian children ≤16 years: a 10-year population-based cohort study

Background: Fractures represent the most common injury-related hospitalisations of children. Injured children often miss days from school, may experience ongoing pain and disability, as well as a reduced quality of life. To monitor temporal trends, and to enable targeted strategies to prevent fracture-related hospitalisation, an examination of the characteristics of hospitalisations by fracture-type is needed. The aim of this study was to investigate the characteristics, health outcomes and hospital treatment costs of fracture hospitalisations and readmissions of children aged ≤16 years in Australia across a 10-year period for the five most common types of fractures. Method: Linked Australian hospitalisation and mortality records during 1 July 2002 to 30 June 2012 were analysed. Hospital treatment costs and length of stay were estimated, and the number and causes of hospital readmissions were identified. Results: There were 287,646 fracture-related hospital admissions in Australia for children ≤16 years. The five most common fracture regions were the forearm (48.1%), shoulder and upper arm (14.1%), lower leg including the ankle (11.3%), wrist and hand (10.4%), and the skull and face (9.0%). There was a decrease in hospitalisation rate for all fractures over the 10-year period. The hospitalisation rate for males was at least double that of females. Falls, particularly those from playground equipment, were the most common injury mechanism. Hospital readmissions within 28 days of hospitalisation were mostly due to further orthopaedic care or rehabilitation. Total treatment costs for fracture-related hospitalisations amounted to over AUD$732 million, with the median cost of readmissions being AUD$2,474. Conclusion: While there is a decline in the rate of hospitalised fractures in Australian children, continued efforts are required if the rate of fractures and their associated economic costs are to be reduced. The identification of the prevalence and causes of various fracture types provides policymakers with evidence to target preventive initiatives.