Hospital Type and Clinical Outcomes for Pediatric Lower-Extremity Open Fracture: Implications for Child Health Services Organizations.

OBJECTIVES: Evaluate associations between hospital type and clinical outcomes for pediatric lower-extremity open fractures. METHODS: Retrospective study of children ≤17 years with lower-extremity open fractures using HCAI (2016-2021). Fractures were categorized as Type I/II or III. Hospitals were categorized as exclusively children's hospitals (ECH), other hospitals with pediatric surgeon coverage (WPS), or without (NPS). Outcomes included time to surgery, length of stay (LOS), discharge disposition, and complications. Multivariate models evaluated associations between hospital type and outcomes. RESULTS: Among 1,118 admissions, 324 (29%) were treated at ECH, 445 (40%) at WPS, and 349 (31%) at NPS. ECH patients had a shorter time to surgery (p = .02), had shorter LOS (p < .001), and were more frequently discharged home (p < .001). Complication rates were similar. Multivariable regression showed WPS and NPS had lower odds of routine home discharge while WPS had longer LOS for isolated fractures. CONCLUSION: ECH provide more efficient care for pediatric lower-extremity open fractures while maintaining comparable complication rates.