Sawyer Jeffrey R, Ivie Conrad B, Huff Ambré L, Wheeler Christopher, Kelly Derek M, Beaty James H, Canale S Terry
Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, LeBonheur Children's Medical Center, Memphis, TN 38104, USA.
J Pediatr Orthop. 2010 Apr-May;30(3):248-52. doi: 10.1097/BPO.0b013e3181d213bc.
The purpose of this review was to determine when and why pediatric patients with cast complaints return to the emergency room (ER). If this could be determined, educational and treatment strategies may help decrease the number of these visits and the cost of care.
Retrospective chart review of patients initially seen in a busy urban pediatric orthopaedic clinic identified those who had an ER visit because of a cast-related problem over a 5-year period. Patients were included only if they were seen for their initial visit and cast application in our fracture clinic.
Of 168 ER visits made by 155 children treated with cast immobilization, 29% were because of a wet cast; 10%, a damaged cast; 23%, a tight cast; 13%, a loose cast; and 10%, pain. In addition to wet and damaged casts, compliance issues included a missed clinic appointment (5%) and being told by medical personnel to return to the ER for a cast check (8%). Several groups with a high risk for return to the ER were identified: the younger the patient, the more likely that the cast was too loose or wet, and the older the patient, the more likely the cast was too tight. Cast type also played a role: a significantly higher rate of return to the ER was found with long arm, long leg, and hand casts. There were no major complications and no child required hospitalization.
All 168 ER visits required only a cast change or reassurance, which could have been done during regular fracture clinic hours; no child required hospitalization or surgery. From these results, a program has been instituted that includes patient education, triage, and follow-up in our fracture clinics to not only improve the quality of patient care but to decrease the financial burden on physicians and the healthcare system.
Economic and decision analysis, Level III.
本综述的目的是确定患有石膏相关问题的儿科患者何时以及为何返回急诊室（ER）。如果能够确定这一点，教育和治疗策略可能有助于减少此类就诊次数和护理成本。
对一家繁忙的城市儿科骨科诊所初诊患者进行回顾性病历审查，确定在5年期间因石膏相关问题返回急诊室的患者。仅纳入在我们骨折诊所进行首次就诊并应用石膏的患者。
在155名接受石膏固定治疗的儿童进行的168次急诊室就诊中，29%是因为石膏潮湿；10%是因为石膏损坏；23%是因为石膏过紧；13%是因为石膏过松；10%是因为疼痛。除了潮湿和损坏的石膏外，依从性问题还包括错过诊所预约（5%）以及医务人员告知返回急诊室进行石膏检查（8%）。确定了几组返回急诊室风险较高的人群：患者年龄越小，石膏过松或潮湿的可能性越大；患者年龄越大，石膏过紧的可能性越大。石膏类型也起到了一定作用：长臂、长腿和手部石膏返回急诊室的比例明显更高。没有重大并发症，也没有儿童需要住院治疗。
所有168次急诊室就诊仅需更换石膏或给予安慰，这些本可在常规骨折诊所时间内完成；没有儿童需要住院或手术。基于这些结果，我们在骨折诊所制定了一项包括患者教育、分诊和随访的计划，不仅要提高患者护理质量，还要减轻医生和医疗系统的经济负担。
经济和决策分析，三级。
