gms | German Medical Science

Objectives/Interrogation: Social deprivation, a measure of socio-economic status, has been shown to negatively affect perceptions of orthopedic conditions and outcomes of treatment. The objective of this study was twofold to assess whether social deprivation would correlate with subjective assessment of function in pediatric patients with congenital hand anomalies.

Methods: All upper extremity (UE) anomalies in patients enrolled in the prospective Congenital Upper Limb Differences (CoULD) registry were classified and subjective function assessed using the Patient Reported Outcome Measurement Information System (PROMIS). PROMIS scores for pain interference, peer relations, anxiety, depression, and UE function were obtained for all patients 5 years and older at initial presentation. Social deprivation was determined by the Area Deprivation Index (ADI) through use of 9-digit zip codes; the index ranges from 0-100 with higher scores being the most deprived. PROMIS scores were correlated with the ADI for all patients.

Results: 375 pediatric patients with congenital UE differences were evaluated. Average age at inclusion was 11 years. 56% were female. 55% of patients had bilateral involvement. There were 247 extremities with a diagnosis of malformation of the entire limb and 261 had a hand plate malformation. 137 limbs had a diagnosis of dysplasia, 4 had a deformation, and 54 had an associated syndrome. Overall, PROMIS scores were within one standard deviation of normal for peer relations, pain, depression, and anxiety. However, PROMIS scores for UE function were more than one SD below the national average (50), both for parent (40) and child (38) scores.

The mean ADI for the cohort was lower than the national average, indicative of less deprivation, with only 14% of patients in the most deprived quartile. Parent PROMIS scores did not vary with ADI scores. In contrast, child reported PROMIS scores for pain, peer relations, and anxiety were statistically different between the highest and lowest quartile. Children with higher social deprivation reported higher pain interference, lower peer relations, and higher anxiety.

Conclusions:

1.

PROMIS scores for UE function were one standard deviation below normal for all patients with congenital hand anomalies, but were normal for the psycho-social measures.

2.

Child reported PROMIS for pain interference, peer relations, and anxiety scores were statistically worse in more socially deprived areas, suggesting more psychosocial challenges in these children.