Overtreatment in the United States

Trends in the Management of Pediatric Trigger Thumb in the United States

BACKGROUND

Recent literature suggests that initial observation of pediatric trigger thumb without early surgical interventions can lead to spontaneous resolution. We sought to analyze current trends in the management of pediatric trigger thumb and compare real-world data with what the literature supports.

METHODS

We conducted a retrospective study of data collected using the PearlDiver database between 2015 and 2018. Patients who were aged younger than 10 years with a diagnosis of trigger thumb were identified using International Classification of Diseases codes. Current Procedural Terminology codes were used to identify patients who had an operation for trigger thumb. Patient demographics, comorbidities, utilization of hand therapy, and treatment cost were also collected.

RESULT

Of the 997 patients included in the study, 69% were diagnosed with trigger thumb between the age of 2 and 5 years. In all, 492 patients (49%) had surgery for trigger thumb: 65% of patients had surgery within 1 year of diagnosis, and 76% patients had surgery before the age of 5 years. This treatment pattern was similar across multiple regions of the United States, and there were no significant predictors for surgery. The average cost of treating patients without surgery was $593/patient, whereas that for patients with surgery was $1363/patient.

CONCLUSIONS

Nationwide data show that pediatric trigger thumb may be managed surgically at higher frequencies and in patients at younger ages than supported by the existing literature. Possible overtreatment is not only detrimental to patients but also burdens the health care system with unnecessary cost.