O2080: Vitamin D Deficiency in Pediatric Fracture Patients Presenting to the Emergency Department: A Protocol for Routine Assessment of Vitamin D in Children with Fractures

Background: There is no consensus on the role of routine screening for vitamin D deficiency in pediatric patients with fractures. Additionally, the rate of vitamin D deficiency in pediatric fracture patients presenting to the emergency department is not well described. Following a pilot study at our institution that showed that 60% of operatively treated pediatric fractures are 25-hydroxyvitamin D (25(OH)D) deficient (<= 20 ng/ml) we sought to investigate the rate of vitamin D deficiency of pediatric fractures in our emergency department.

Methods: A prospective observational study was performed on patients 1–18 years old presenting to a level 1 trauma center emergency department with a fracture. We developed a protocol that included drawing 25(OH)D levels on all fracture patients that required intravenous access for management of their condition. All patients with fractures received their first dose of vitamin D supplementation in the emergency department in the form of 50, 000 IU ergocalciferol prior to discharge. Lab results were obtained as an outpatient and continuation of vitamin D supplementation if insufficiency (less than 30 ng/mL) or deficiency (less than 20 ng/mL) was diagnosed. Chart review was performed for patient demographics, fracture diagnosis and treatment, 25(OH)D result, and radiographs.

Results: 231 pediatric patients were included in the study from September 2021 – February 2022. The average 25(OH)D of the cohort was 23.7 ng/ml. 94 (40.7%) were found to be deficient and 85 (36.8%) were insufficient meaning 77.5% of patients had 25(OH)D below normal ( < 30 ng/ml). 65 Caucasian patients were included with an average 25(OH)D of 26.6. 164 non-Caucasian patients were included with an average 25(OH)D of 22.5. 134 patients (58%) received a dose of 50, 000 IU ergocalciferol prior to discharge.

Conclusion: We found the rate of vitamin D deficiency in pediatric fractures in the emergency department (77.5%) to be twice the previously reported rates. 25(OH)D deficiency has been associated with an increased risk of fracture. Thus, we are seeing more patients that have a modifiable risk factor for fracture. These findings support development of a practical protocol for obtaining Vitamin D levels on pediatric fracture patients and initiating supplementation prior to emergency room discharge.