An Evaluation of the Accuracy and Necessity of Fracture Clinic Referrals in a Busy Pediatric Emergency Department.

OBJECTIVES: Injuries account for approximately 18% of all pediatric emergency department presentations. Of these, a significant amount will have fractures that will require orthopedic management usually in the orthopedic fracture clinic. Our aim was to assess the accuracy and necessity of fracture clinic referrals from our emergency department and to suggest an approach that might safely reduce the referral numbers.

METHODS: All fracture clinic referrals from Temple Street Emergency Department in August 2013 were retrospectively audited.

RESULTS: There were 339 fracture clinic referrals in August 2013. Of these, 213 (63%) had fractures as reported by a consultant radiologist. One hundred twenty-six (37%) had no fracture confirmed, and of these, 24 (19%) had no fracture seen in the emergency department but were referred as clinically fractured. Thirty-three (10%) of the 339 were buckle fractures of the wrist. There were 21 (6.2%) finger injuries referred. Of ankle injuries referred to fracture clinic (n = 43), 14 (33%) were confirmed Salter-Harris 1 or 2 or avulsion fractures of the lateral malleolus and 16 (37%) were suspected Salter-Harris 1 or 2 fractures of the lateral malleolus.

CONCLUSIONS: Through education and policy change such as the establishment of an Advanced Nurse Practioner (ANP)-led clinic or a virtual clinic within our emergency department, we could safely and efficiently reduce orthopedic fracture clinic referrals by more than 30%.