159: From the Emergency Department to a Community office – Primary Care Physician Follow Up of Buckle Fractures of the Distal Radius

Buckle fracture of the distal radius is a very stable injury with an excellent prognosis. Evidence recommends treatment with a removable wrist splint and follow up with a primary care physician (PCP). 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 experienced specialty consultation or lacked any physician follow up. We also examined clinical outcomes and parental satisfaction. This was a prospective cohort study at an urban, tertiary care pediatric emergency department (ED). Eligible children were 2–18 years of age diagnosed with a distal radius buckle fracture, treated with a removable splint, and referred to a PCP for follow up within two 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. We enrolled and completed phone follow up for 129 children. (Figure 1) 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 any physician follow up. Of the 99 seen by the PCP, 78 (78.8%) were seen within 2–3 weeks and 95 (96.0%) had one visit. 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. Follow up of ED diagnosed distal radius buckle fractures was not successfully completed exclusively at the PCP office in approximately one-third of cases. Barriers to a higher success rate included inaccurate initial diagnosis by the ED physician, and parental and PCP perceptions of appropriate clinical indications for specialty consultation.