Pediatric orthopaedic patients presenting to a university emergency department after visiting another emergency department: demographics and health insurance status

BACKGROUND: The disparity in access to and delivery of health care among children has become increasingly apparent. The purpose of our study was to analyze demographic information, including health insurance status, of children with extremity injuries seen at a University Hospital emergency department (UH ED) after visiting another ED for the same complaint. METHODS: A database of pediatric orthopaedic consults requested for extremity injuries at UH ED was reviewed. Information regarding patients' age, ethnicity, orthopaedic diagnosis, type of health insurance, time from injury to presentation at the first ED and at UH ED, mode of transportation to UH ED, and orthopaedic treatment rendered was analyzed. All patients with Medicaid, health maintenance organization-Medicaid, no insurance, or charity care were classified as having public insurance, whereas those with commercial insurance, including health maintenance organization and preferred provider organization plans, were placed in the private insurance category. RESULTS: Over a 30-month period, 125 children, of whom 18% had private health insurance, were noted to have recently visited another ED seeking treatment for an extremity injury. A closed fracture was diagnosed in 117 patients, 94% of whom were discharged from UH ED after cast application. There was no difference with regard to patients' age, sex, ethnicity, diagnosis, and time to presentation at the initial ED between private and public insurance groups. However, 52% of children with private insurance received orthopaedic care within 24 hours compared with 22% with public insurance (P = 0.013). Children with public insurance were more likely to have visited another health facility besides the initial ED before presenting to UH ED (P = 0.004). Moreover, 74% of privately insured patients presenting to UH ED arrived via ambulance compared with 34% with public insurance (P < 0.001). CONCLUSIONS: Most children with an extremity injury who received orthopaedic consultation at a tertiary-level ED after visiting another ED had an isolated fracture requiring cast treatment only. There was a trend for delay in receiving definitive orthopaedic care for patients with public health insurance compared with those with private insurance.