title: Factors Associated With Orthopedic Aftercare in a Publicly Insured Pediatric Emergency Department Population.
abstract: OBJECTIVE
  Children with public insurance are less likely than children with private insurance to obtain follow-up care after emergency department (ED) care. This study aimed to determine if specific demographic and clinical factors are associated with aftercare compliance in a population of publicly insured pediatric ED patients with orthopedic injuries.
  
  
  METHODS
  This was a retrospective case-control study of Washington, DC, children aged 0 to 17 years with public insurance discharged with isolated forearm fractures from the Children's National Medical Center ED from 2003 to 2006. Bivariable analyses and multivariable logistic regression were performed to measure the association between sociodemographic variables and failure to follow up.
  
  
  RESULTS
  Six hundred children met the inclusion criteria. The overall cohort was 63.7% male and 81.7% African American, with a mean age of 8.8 (SE, 0.2) years. Overall, 85.7% of patients went to a follow-up orthopedic appointment, and 68.2% of patients had timely orthopedic follow-up, defined as 14 days or less after discharge from the ED. Treatment with orthopedic reduction (adjusted odds ratio [OR], 2.0 [1.33-2.93]) was positively associated with timely orthopedic follow-up, whereas older age (adjusted OR, 0.9 [0.88-0.97]) was significantly associated with failure to follow up. In the subset of patients who required orthopedic reduction in the ED, older age was significantly associated with failure to follow up (adjusted OR, 0.80 [0.74-0.94]).
  
  
  CONCLUSIONS
  Mild fracture severity is associated with lack of orthopedic follow-up for patients with public insurance. Older age was associated with lack of follow-up, even in the subgroup with severe fractures. Targeted interventions to improve orthopedic aftercare compliance should focus on older patients with severe forearm fractures.
authors.affiliation: From the *Division of Emergency Medicine, Children's National Medical Center, Washington, DC; and †Division of Emergency Medicine, Johns Hopkins Children's Center, Baltimore, MD.
authors.forename: Nazreen
authors.initials: N
authors.lastname: Jamal
authors.forename: Sabah Fatima
authors.initials: SF
authors.lastname: Iqbal
authors.forename: Leticia Manning
authors.initials: LM
authors.lastname: Ryan
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D000359:Aftercare / Q000191:economics / Q000458:organization & administration*; D000367:Age Factors; D001071:Appointments and Schedules; D016022:Case-Control Studies; D002648:Child; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000473:pathology / Q000628:therapy*; D050723:Fractures, Bone / Q000473:pathology / Q000628:therapy*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data*; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data*; D009985:Orthopedics / Q000191:economics / Q000458:organization & administration*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014861:Washington