The purpose of this study was to analyze demographic information, including health insurance, of children with extremity injuries seen at a university emergency room after visiting an outside institution for the same complaint. The authors have noted an increasing number of children with isolated closed fractures being referred from the community. One of the considerations was, whether or whether not patients with public health insurance had a delay in the delivery of definitive Orthopaedic care of their injuries.
A database of all Orthopaedic consultations was performed over nearly a two year time period at a large university that is a level 1 trauma center. The authors recorded their injured extremity, along with a variety of other information including insurance plans. Standard data analysis was performed. Over a thirty month period, 125 children with extremity trauma who had previously visited another emergency room were identified. The majority of the injuries were fractures and the majority affected the upper limb. There were 75 boys and 50 girls with an average age 8 years. Ethnicity was 64 black, 24 hispanic, 10 white, and 27 children with other ethnic backgrounds. With regard to health insurance, 18% had private and 82% had public insurance. Most of the children were discharged from the university emergency room after cast application and only 8 patients or 6% required admission.
The average time from injury to presentation of the first emergency room was 0.5 days, and presentation at the university averaged 2.5 days. Seventy-three patients were brought to the emergency room by their caregivers, whereas fifty-two patients were transported via ambulance. Only 34% of patients with public insurance were transported via ambulance, compared to 74% with private insurance.
Various explanations are provided to explain the author’s findings. Certainly, patients with public insurance exhibit different health care seeking behavior then those with private insurance. Many used the emergency room as a primary care facility. However, emergency departments are becoming a financial liability for many hospitals, because of their primary portal for uninsured and publicly insured patients. The decreased number of physicians accepting public insurance may or may not be contributing factor for this subsequent referral to the university.
This article highlights the differences and discrepancies in children with fractures or soft-tissue injuries treated at the community or university. Racial, economic, and social factors certainly play role. Previous studies have shown this to be a persisted trend and Congress in 1985 passed the emergency medical treatment act to try to decrease “patient dumping.” Obviously, this act has done little to change referral pattern between emergency rooms and institutions.
Emergency, Room, Insurance, Uninsured, Pediatric