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

Abstract

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.

Trigger Thumb in Pediatric Patients: A 20-Year Update

“…Regarding factors that are predictive of surgery, a recent large national claims database study by Park et al 13 looked at treatment trends in 997 patients, with 69% falling between the ages of 2 and 5 years, similar to our cohort (64.7%). The rate of surgical intervention in their study was 49%.…”

“…6,12 There are also factors inherent to the patient's condition that are not controllable, such as baseline degree of interphalangeal joint contracture, that may negatively affect the outcome of nonoperative management strategies. 11 Regarding factors that are predictive of surgery, a recent large national claims database study by Park et al 13 looked at treatment trends in 997 patients, with 69% falling between the ages of 2 and 5 years, similar to our cohort (64.7%). The rate of surgical intervention in their study was 49%.…”

Prevalence and Characteristics by Age and Sex in Pediatric Trigger Digits: Nationwide Analysis Using Korea Health Insurance Dataset

“…In a study conducted in the United States, it was reported that 69% of patients were diagnosed with trigger thumb between the ages of 2 and 5 years. 23) In our study, the mean age at initial diagnosis was 2.76 ± 1.91 years, and 86.9% of patients were diagnosed with TDs till the age of 5 years. We found that the diagnoses of pediatric TDs decreased rapidly after the age of 5 years.…”

“…Park et al 23) reported that 49% of the patients underwent surgery for trigger thumbs in the United States: 65% of the patients underwent surgery within 1 year of diagnosis, and 76% of the patients underwent surgery before the age of 5 years. In our study, patients with pediatric TDs underwent surgery at an average age of 3.79 ± 2.19 years.…”