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Accuracy of Emergency Room and Urgent Care Center Pediatric Upper Extremity Diagnoses
Karan Dua, MD; Anna Schoonover, BA; Joshua M. Abzug, MD
University of Maryland School of Medicine, Baltimore, MD

Introduction: Urgent care centers and emergency rooms are the first line in diagnosing and managing acute pediatric upper extremity injuries. Diagnosis and management of acute upper extremity injuries in the pediatric population can be challenging because of the difficulty obtaining a thorough physical examination and skeletal immaturity on radiographs. The purpose of this study is to assess the accuracy of the diagnosis patients receive from emergency rooms and urgent care centers.
Materials and Methods: All patients who presented for initial injury evaluation after being seen in an urgent care center or outside emergency room were recruited prospectively for this study. Patients who were not given official documentation detailing their injury were excluded. A blinded comparison was made between the official discharge diagnosis and the diagnosis made at evaluation by the orthopaedic surgeon. Simple statistics were performed.
Results: 48 patients were enrolled including 33 patients triaged in emergency rooms and 15 in urgent care centers. The overall correct diagnosis rate was 73% (35/48). Emergency rooms diagnosed acute pediatric upper extremity injuries 70% (23/33) correctly in comparison to 80% (12/15) in urgent care centers. Of the 13 incorrect diagnoses, nine were missed fractures (both-bone forearm, supracondylar, distal radius, proximal humerus, metacarpal, scaphoid, and monteggia variant), one was a missed elbow sprain, two were misdiagnosed fractures as sprains, and one patient with a healing supracondylar fracture was misdiagnosed as a new injury.
Conclusion: Emergency room and urgent care center diagnoses of acute pediatric upper extremity injuries are only accurate 73% of the time. Better education is likely needed for emergency room and urgent care center providers in order to improve accuracy when diagnosing acute pediatric upper extremity injuries.


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