DELAY IN DIAGNOSIS AND MANAGEMENT OF ADOLESCENT ANTERIOR CRUCIATE LIGAMENT INJURIES IN A PUBLICLY FUNDED HEALTHCARE SYSTEM
Bibliographic record
Abstract
Background: Delay to surgical anterior cruciate ligament (ACL) reconstruction after injury has been associated with increased frequency and severity of meniscal and articular cartilage pathology. Patient factors that contribute to delayed ACL reconstruction are not well understood. Hypothesis/Purpose: Identify patient factors contributing to delayed ACL reconstruction in a publicly funded healthcare system. Methods: A retrospective review of all patients who had a primary ACL reconstruction at a single institution between 2014 and 2018 was completed. Patient demographic data, side, history of physical therapy, and intraoperative status of the meniscus and articular cartilage were collected. Household income was determined based on federal census data of mean household income by postal code. Time from injury to orthopedic referral (W0), consult (W1), and ACL reconstruction (W2) was calculated. A logistic regression model was constructed to determine the impact of household income, age, and sex on W0, W1, and W2. Results: Eighty-three patients were identified with a mean age of 14 years (range, 9-17). Twenty-eight patients were male (33.7%). Mean time from injury to orthopedic consult was 124 days (range, 0-1096). Mean time from injury to reconstruction was 286 days (range, 51-1623). Eleven patients (13%) had ligament reconstruction within 90 days of injury. Fifty-three patients (63.8%) had meniscal or articular cartilage damage at the time of ACL reconstruction. There was no significant effect of patient sex, age, or history of physical therapy on time to ACL reconstruction. Household income was found to have a significant effect on time to ACL reconstruction. For every $10,000.00 increase in household income, time to reconstruction was reduced by 19%. Using median time to reconstruction (223 days), this represents a decrease of 42 days. Household income only had an effect on W0 with a decrease of 38.4% for every $10,000.00 incremental increase in household income. No association was found between time to ACL reconstruction and odds of meniscal or articular cartilage damage. Conclusion: At a pediatric tertiary care hospital in a public health care system, most adolescent patients are having their ACL reconstructed in a delayed fashion contributing to an increased frequency of intra-articular pathology. Increase in household income was associated with a significant decrease in time to orthopaedic referral. There was no difference in wait time for consultation (W1) or wait time for surgery (W2). Further research is needed to determine specific factors causing this discrepancy in access to healthcare within a publicly funded system.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".