Poststabilization care for pediatric fractures: a follow-up survey
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Ilene Claudius1, David Skaggs, Alan Nager
1Division of Emergency Medicine, Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. iclaudius@chla.usc.edu
Insights
Over one-third of pediatric fracture patients in this study did not receive recommended orthopedic follow-up after emergency department visits. This lack of timely care may increase the risk of poor outcomes for children with fractures.
Area of Science:
- Pediatric Orthopedics
- Emergency Medicine
- Healthcare Access
Background:
- Patient compliance with emergency department (ED) follow-up instructions is often inadequate.
- Children with Medicaid insurance face documented disparities in accessing orthopedic care compared to privately insured children.
- Understanding follow-up compliance is crucial for optimizing pediatric fracture management.
Purpose of the Study:
- To determine the rate of compliance with ED follow-up recommendations for pediatric fracture patients.
- To identify specific barriers preventing pediatric patients from obtaining recommended orthopedic follow-up care.
Main Methods:
- A telephone survey was conducted with pediatric patients who sustained fractures and received splinting in a level 1 pediatric trauma center ED.
- Inclusion criteria focused on patients instructed to seek orthopedic consultation for definitive fracture care.
- The study population primarily consisted of patients insured by Medicaid.
Main Results:
- Out of 82 eligible pediatric patients, 66 completed the telephone interview.
- A significant proportion, 34.7%, did not receive the recommended follow-up with an orthopedist.
- Barriers included perceived lack of need for follow-up (11 patients) and failure to be referred by a primary care physician (PCP) after initial follow-up (12 patients).
Conclusions:
- More than one-third of children with non-emergent fractures treated in the ED did not receive the recommended orthopedic follow-up.
- While patient outcomes were not assessed, existing orthopedic literature indicates that delayed follow-up increases the risk of adverse outcomes.
- This highlights a critical gap in care for pediatric fracture patients, particularly those with Medicaid insurance.
Objectives:
Compliance with emergency department instructions regarding patient follow-up is generally poor. Children with Medicaid have been previously shown to have less access to orthopedic care than those with private insurance. Our objectives were to quantify the compliance of pediatric fracture patients with recommended emergency department follow-up and to identify barriers for patients who do not follow-up.
Methods:
Telephone survey of pediatric fracture patients seen and splinted between July and September of 2004 in a level 1 pediatric trauma center emergency department serving primarily a Medicaid-insured population. Those patients instructed to obtain an orthopedics consultation for definitive care of their fracture were included.
Results:
Eighty-two patients were identified and met inclusion criteria. Of these, 66 families completed a telephone interview; 34.7% of patients did not receive follow-up with an orthopedist. Eleven patients elected not to follow-up with their PCP, mostly secondary to perceived lack of need. Twelve patients followed up with their PCP but were not referred to an orthopedist.
Conclusion:
Over one third of children with nonemergent fractures treated in our emergency department did not receive recommended follow-up. Although our data cannot comment on the outcomes of these specific patients, the orthopedic literature suggests that these children are at higher risk of a poor outcome than those receiving timely follow-up.
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