O2070: The Effect of Socioeconomic Factors on Delays in Obtaining Pediatric Knee Mris

Background: The timing of MRI ordering and completion has been used as a marker of timely diagnosis and treatment. While the reasons behind delays are likely multifactorial, a growing body of evidence is emerging suggesting a link between socioeconomic status and untimely care. While insurance status is a reasonable marker for socioeconomic status, a more comprehensive scoring system is the Social Deprivation Index (SDI), a composite measure of demographic characteristics collected in the American Community Survey. SDI is a validated, county-level, easily accessible measure of socioeconomic variation in health outcomes based on seven criteria: income, education, employment, housing, household characteristics, transportation, and demographics. The purpose of this project is to determine how socioeconomic factors affect the timing of orthopedic care, elucidating the impacts of socioeconomic factors on care in area, and aiding providers in mitigating the factors associated with delays in treatment.

Methods: A retrospective chart review was completed of patients 21 and younger with a history of lower extremity sports medicine (ligamentous/soft tissue injury, structural abnormality, instability, inflammation) MRI between 5/26/2017 and 12/28/2020. Patients were from 3 states and attended to by physicians associated with an urban academic institution. Patients were assigned SDI score based on their ZIP code. Excluded from the study were patients with a non-knee related diagnosis (hip, foot, or ankle), patients from zip codes with unknown SDI, and non-sports medicine diagnoses (tumor, infection, fracture).

Results: Analysis of 355 patients revealed no significant delays in pediatric knee care based on SDI score Specifically, in a regression analysis there were no significant difference in time from injury to clinic appointment (p=0.7), no significant delays in ordering MRI imaging (p=0.3) and no significant difference in time from MRI to surgical management (p=0.7) and from injury to surgical management (p=0.9).

Conclusion: SDI, a measure of socioeconomic status, has been previously shown to negatively affect outcomes of orthopedic treatment. Surprisingly, our study shows no time delays in obtaining advanced imaging (MRI) and time to surgical management of knee injuries in our pediatric population.