Prior treatment of fracture patients in a tertiary pediatric emergency department: Informal referrals from other emergency departments

BACKGROUND: The purposes of this study were to determine the following: (1) the percentage of fracture patients at a tertiary pediatric emergency department (ED) who previously sought treatment for the injury elsewhere and (2) how often such patients were sent from another ED. METHODS: A prospective survey was conducted in the ED of a tertiary pediatric medical center in a large metropolitan area. Patients who presented with suspected extremity fractures and previously sought treatment elsewhere were asked where they had sought treatment and whether staff at another ED had told them to come to the tertiary ED. Demographic, clinical, insurance, and transfer information were also collected. RESULTS: Ninety-two patients who had sought previous care for the injury elsewhere participated in the survey, with 82 (89%) ultimately being diagnosed with fractures. This represents 33% (82/246) of the patients with extremity fractures treated by the participating ED physicians during the study. Seventy-nine percent (73/92) of the subjects had previously sought treatment at another ED. For those who did not also visit a regular physician, 69% (37/54) were told to come to the tertiary ED by staff at the initial ED. No differences were observed based on race or insurance status because the study subjects were predominantly minority (91%, including 80% Hispanic) and lacking private insurance (84%). CONCLUSIONS: Seeking follow-up care in a tertiary ED, often on the advice of staff from another ED, is a common practice for this largely minority and poorly insured population. Because patients did not present to our ED until an average of 3 days after injury and many had been discharged to a primary care physician, it is likely that many of the patients did not require emergency care. This practice inefficiently uses limited emergency care resources. LEVEL OF EVIDENCE: Level II prospective survey.