Dissertation (Masters) Is Hospital Type Associated with Application of Best-evidence Treatment Recommendations for Children’s Low-risk Distal Radius Fractures Treated in Ontario Emergency Departments?


Tara Baxter


Objectives: Investigate the association of hospital and physician type with the application of best-evidence treatment for low-risk distal radius fractures in children aged 2-14 treated in Ontario emergency departments from 2003-2015. Methods: Retrospective population-based cohort study using administrative data. Multivariable log binomial regression was used to quantify associations between hospital and physician type and best-evidence treatment. Results: 70,801 fractures were analyzed. Only 21% received best-evidence care. Significant associations were identified between best-evidence treatment and paediatric (RR 1.16, 95%CI 1.07-1.26), community (RR 1.13, 95%CI 1.06-1.20), or small (RR 1.86, 95%CI 1.72-2.01) hospitals, and treatment by FP/GP (RR 1.09, 95%CI 1.02-1.16), paediatrician (RR 1.22, 95%CI 1.11-1.34), or subspecialty paediatric emergency medicine training (RR 1.73, 95%CI 1.56-1.92). Conclusion: Hospital and physician types involved in generating best-evidence are most successfully implementing it.


Andrew Howard