From the Emergency Department to a Community Office – Primary Care Physician Follow Up of Buckle Fractures of the Distal Radius
CPS ePoster Library. Koelink E. Jun 25, 2015; 99220; 159
Dr. Eric Koelink
Dr. Eric Koelink
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Abstract
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Background
Buckle fractures of the distal radius are very stable injuries with an excellent prognosis. Evidence recommends treatment with a removable wrist splint and follow up with a primary care physician (PCP).

Objectives
Our main objective was to determine what proportion of children with a distal radius buckle fracture who were referred to the PCP for follow up subsequently had specialty consultation or lacked any recommended physician follow up. We also examined clinical outcomes and family satisfaction with PCP follow up.

Methods
This was a prospective cohort study at an urban, tertiary care pediatric emergency department (ED). We enrolled children 2-18 years of age diagnosed with a distal radius buckle fracture who were treated with a removable splint and referred to a PCP for follow up within 1-2 weeks of the injury. We telephoned families 28 days after their ED visit and recorded physician follow up visits and parental satisfaction with PCP follow up on a five-point categorical scale.

Results
We enrolled and completed phone follow up in 129 (93.4%) cases (Figure). The mean (SD) age was 8.2 (3.5) years, 55.8% were male, and 124 (96.1%) had a PCP. Overall, 46 (35.7%; 95% CI 27.4, 44.0) children experienced specialty consultation or lacked physician follow up completely. Of the 99 seen by the PCP, 78 (78.8%) were seen within 2-3 weeks and 95 (96.0%) were seen once. Ninety-five (92.5%) parents reported being "very satisfied/satisfied" with the care they received at the PCP office for this injury. None of the distal radius fractures required specialty consultation due to clinically significant complications and all cases were reported by parents as fully recovered at phone follow up.

Conclusions
Follow up of ED diagnosed distal radius buckle fractures was successfully completed exclusively by the PCP in approximately two-thirds of cases. Barriers to higher success rates included accurate initial diagnosis by the ED physician, and parental and PCP perception of appropriate clinical indications for specialty consultation.
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