our work and for hanging around to the end of the conference. Please see the disclosure program for all of our disclosures, none of which are pertinent. So a little bit of background information. So pediatric patients are a vulnerable population. They depend frequently on family, friends to identify injuries, potentially to transport them to appointments. So delaying treatment is pretty well borne out in the literature, can increase the risk of secondary injuries, both including meniscal and chondral injuries. And there have been prior studies which are for the most part hypothetical, and these have been fictitious patients which have been presented to clinic offices and have been called upon in which the appointment directors will then depend if the timing and presentation of their appointment. So the purpose of this study was to determine the impact of insurance status on the access to sports medicine care. Our hypothesis was that patients with Medicaid or uninsured or pro bono insurance coverage would have delayed presentations compared to the privately insured counterparts. This is a retrospective case series over a four and a half year period of which we looked at patients that were 18 years or younger. Initially we looked at a kind of a more broad array of injuries. We then focused upon procedural codes that looked at ACL reconstruction and meniscal injuries, more specifically bucket handle meniscal injuries due to the increased time acuity of the injury. We then collected demographic and injury data, including the date of the injury, the date of presentation, their insurance status, whether they required an interpreter, and their distance from our clinic, whether they were also referred to our clinic. Here are our results. We had a total of 190 patients that met inclusion criteria, 177 of which had ACL reconstruction, 13 of which had bucket handle meniscal repair, and these were isolated injuries. As you can see, 78 patients that had the ACL reconstruction, 78 patients were private insurance. This was 44%. 74 patients were underinsured, which we defined as having pro bono or Medicaid insurance. 25 patients were TRICARE insurance, which is a military type of insurance. For the bucket handle meniscal repair, six of which were private insurance or 46%, 7% were again underinsured, which is 54%. Then specifically looking at the presentation time to our clinic, and this is based on the reported date of injury to their presentation at our clinic. Looking at the ACL reconstruction group, we divided this into private insurance and TRICARE insurance versus Medicaid and pro bono. For the 33 out of the 103 patients that had either private or TRICARE insurance, 32% had delayed presentation greater than 30 days, while the Medicaid and pro bono group, 39 out of the 74 patients or 53% had delayed presentation greater than 30 days, and this was statistically significant. For the isolated bucket handle meniscal tears, zero out of the six patients or 0% had delayed presentation versus six out of seven, or 86% had delayed presentation greater than 30 days, and again, this was statistically significant. This is essentially a visual way to interpret that data. This is a Kaplan-Meier survival curve, which looked at the proportion unseen on the y-axis in days and the x-axis. For the red data on the right hand of the screen, this is the Medicaid and pro bono insurance patients separated out via ACL versus the bucket handle, and the blue is the private or TRICARE insurance, and you can see there's an increased lag time to presentation for the Medicaid and pro bono insurance patients. So in conclusion, patients with Medicaid or pro bono insurance had a delayed initial presentation compared to their counterparts that had private insurance, and really further research is really required to explicitly correlate the disparities in access to care and whether this leads to poor outcomes in these patients. Thank you.

insurance status

access to sports medicine care

pediatric patients

Medicaid

uninsured insurance