title: Primary care management for isolated limb injury: referral to orthopedic surgery in a trauma center.
abstract: BACKGROUND
  Musculoskeletal injuries affect up to 13% of adults annually. Despite this high incidence, quality of primary care, including analgesia, may be sub-optimal. The goal of this study is to describe the quality of primary care for ambulatory patients with isolated limb injury and to identify related factors.
  
  
  METHODS
  A cross sectional study was undertaken prospectively on 166 consecutive ambulatory adult patients with isolated limb injury who presented to orthopedics service in a Level one Trauma Centre. Quality of care was assessed by evaluating analgesia, walking aids, immobilization, and quality of referral diagnosis according to actual expert recommendations.
  
  
  RESULTS
  This study revealed low quality of primary care for 82 (53.2%) of injured patients. Seventy-three patients (50.3%) had pain level over 5/10 and 45 cases (28.5%) had insufficient/absent analgesia prescriptions. Fifty-one (32.3%) had unacceptable immobilization and 21/59 (35.6%) patients with a lower limb injury did not receive a walking aid prescription. A total of 61 patients (36.7%) had an absent or inadequate referral diagnosis. Factors associated with lower quality depended on the specific quality indicator and included: living further away from the hospital, younger age, initially consulting at another health care center, having a fracture, and being a smoker.
  
  
  CONCLUSIONS
  The high frequency of low quality of care underlines the necessity for orthopedic surgeons to be involved in primary care education. Identifying factors associated with lower quality of care will orient efforts to improve medical care of patients with isolated traumatic injury.
authors.affiliation: Service d'Orthopédie, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada H4J 1C5. dominique.rouleau@umontreal.ca
authors.forename: Dominique M
authors.initials: DM
authors.lastname: Rouleau
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
authors.forename: Debbie Ehrmann
authors.initials: DE
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000700:Analgesics / Q000627:therapeutic use; D002170:Canada; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005121:Extremities / Q000293:injuries*; D005260:Female; D005592:Fracture Fixation / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009983:Orthopedic Equipment / Q000706:statistics & numerical data; D009985:Orthopedics / Q000706:statistics & numerical data*; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012907:Smoking; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014910:Wheelchairs / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000700:Analgesics