title: Symptoms and time to medical care in children with accidental extremity fractures.
abstract: OBJECTIVE
  Delay in seeking medical care is one criterion used to identify victims of abuse. However, typical symptoms of accidental fractures in young children and the time between injury and the seeking of medical care have not been reported. We describe patient and injury characteristics that influence the time from injury to medical care.
  
  
  METHODS
  Parental interviews were conducted for children <6 years old with accidental extremity fractures. Demographic characteristics, signs and symptoms of the injury, and fracture location and severity were described and examined for their association with a delay (>8 hours) in seeking medical care.
  
  
  RESULTS
  Among 206 children, 69% had upper extremity fractures. The median time to the first medical evaluation was 1 hour, but 21% were seen at >8 hours after injury. Although 91% of children cried after the injury, only 83% were irritable for >30 minutes. Parents observed no external sign of injury in 15% of children, and 12% used the injured extremity normally. However, all parents noted at least 1 sign or symptom. Minority children (odds ratio [OR]: 2.54 [95% confidence interval [CI]: 1.18-5.47), those with lower extremity injuries (OR: 2.23 [95% CI: 1.01-4.90]), those without external signs of injury (OR: 3.40 [95% CI: 1.36-8.51]), and those with continued extremity use (OR: 3.26 [95% CI: 1.22-8.76]) were more likely to delay seeking medical care.
  
  
  CONCLUSIONS
  Although some children did not manifest all expected responses, no child with an accidental fracture was asymptomatic. Delay in seeking medical care was associated with more subtle signs of injury; however, delays identified in minority patients are unexplained.
authors.affiliation: Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. farrellc1@email.chop.edu
authors.forename: Caitlin
authors.initials: C
authors.lastname: Farrell
authors.forename: David M
authors.initials: DM
authors.lastname: Rubin
authors.forename: Kevin
authors.initials: K
authors.lastname: Downes
authors.forename: John
authors.initials: J
authors.lastname: Dormans
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Christian
mesh_terms: D001134:Arm Injuries / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D002652:Child Behavior; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007869:Leg Injuries / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008913:Minority Groups; D010342:Patient Acceptance of Health Care; D013997:Time Factors