Poststabilization care for pediatric fractures: a follow-up survey.
OBJECTIVE
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.


CONCLUSIONS
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.
Claudius
Ilene
I
Division of Emergency Medicine, Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. iclaudius@chla.usc.edu
Skaggs
David
D
Nager
Alan
A
D002648:Child; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies