title: Quality of evaluation and management of children requiring timely orthopaedic surgery before admission to a tertiary pediatric facility.
abstract: The purpose of this study was to investigate the quality of evaluation and management of children requiring timely orthopaedic surgery before admission to a tertiary pediatric facility. A retrospective chart review was performed on 372 consecutive children who underwent orthopaedic surgery for a diagnosis of fracture, infection, slipped capital femoral epiphysis (SCFE), or compartment syndrome during a 22-month period at the authors' facility. Of the 372 children, 142 children (38%) first received medical care elsewhere; these are the subjects of this study. Before being seen at the authors' institution, 27 children (19%) had a problem in treatment or diagnosis and 18 (13%) had a delay in diagnosis or treatment of greater than 48 hours. Problems in diagnosis included five children with unrecognized open fractures, four of whom did not receive antibiotics; six children with missed SCFE, five of whom were not made non-weight-bearing; and six missed closed fractures. Delay in treatment occurred for 15 fractures, with a mean delay of >7 days until surgical treatment. Insurance status and primary language of the family were not associated with problems or delays in treatment. Overall, 32% of children undergoing time-sensitive orthopaedic surgery at a tertiary pediatric center had problems or delays in the medical care they received before transfer.
authors.affiliation: Department of Orthopedic Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA. dskaggs@chla.usc.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Roy
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
authors.forename: Candice
authors.initials: C
authors.lastname: Pfiefer
authors.forename: Glenn
authors.initials: G
authors.lastname: Baird
authors.forename: Dominic
authors.initials: D
authors.lastname: Femino
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kay
mesh_terms: D002140:California; D002648:Child; D003161:Compartment Syndromes / Q000175:diagnosis; D004839:Epiphyses, Slipped / Q000175:diagnosis; D050723:Fractures, Bone / Q000175:diagnosis; D006801:Humans; D007239:Infections / Q000175:diagnosis; D007802:Language; D019637:Orthopedic Procedures; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors