Ronksley, Paul EverettHartley, Rebecca Lauren2019-06-192019-06-192019-06-18Hartley, R. L. (2019). Derivation and Internal Validation of a Prediction Model for Hand Fracture Referral Among Pediatric Patients (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.http://hdl.handle.net/1880/110508Pediatric hand fractures are common however, which fractures should be referred for specialist care remains unclear. This thesis aimed to develop a prediction model to identify which acute pediatric hand fractures required referral to a hand surgeon. Data was collected on consecutively referred pediatric hand fractures to a plastic surgery clinic over two years. The primary outcome was necessary referral, defined as fractures that required surgery, closed reduction or more than four appointments. Multivariable logistic regression with bootstrapping was used to derive and internally validate a model, which was then translated into a risk index. Of 1,173 fractures, 417 (35.6%) met criteria for a necessary referral. The multivariable model identified six significant predictors: angulation, condylar involvement, dislocation or subluxation, displacement, open fractures, and rotation and had strong performance (C-statistic 0.88). The risk index, with a threshold 1 point, had a sensitivity of 96.4% and specificity of 45.5%. A simple prediction model was developed to identify which acute pediatric hand fractures required referral to a hand surgeon. While these results require external validation prior to clinical use, this tool may help identify high risk patients and allow for targeted referral.engUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.pediatrichand fractureprediction modelEpidemiologyMedicine and Surgerymaster thesis10.11575/PRISM/36644