Poststabilization care for pediatric fractures: a follow-up survey

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.

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.

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.

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.