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Injury Type and Emergency Department Management of Orthopaedic Patients Influences Follow-up Rates

Coleman, Michelle M. MD; Medford-Davis, Laura N. MD; Atassi, Omar H. MD; Siler-Fisher, Angela MD; Reitman, Charles A. MD

Journal of Bone & Joint Surgery - American Volume: 1 October 2014 - Volume 96 - Issue 19 - p 1650–1658
doi: 10.2106/JBJS.M.01481
Scientific Articles
Disclosures

Background: Orthopaedic clinic follow-up is required to ensure optimal management and outcome for many patients who present to the emergency department (ED) with an orthopaedic injury. While several studies have shown that demographic variables influence patient follow-up after discharge from the ED, the objective of this study was to examine orthopaedic-related and other factors associated with the failure to return for orthopaedic outpatient management, so-called “no-show,” after an ED visit.

Methods: A chart review was conducted at a large academic public hospital. Four hundred and sixty-four consecutive adult patients who received an orthopaedic consult in the ED with subsequent referral to the orthopaedic clinic from January through June, 2011, were included. With use of chi-square and Mann-Whitney univariate tests, data regarding injury type and management were analyzed for association with no-show. Variables with p < 0.25 were included in a multivariate stepwise forward logistic regression analysis.

Results: The overall no-show rate was 26.1%. Logistic regression modeling revealed significant differences in no-show rates based on cause of injury (odds ratio [OR] 7.51; 95% confidence interval [CI], 2.27 to 25.1), with assault victims having the highest no-show rate. Anatomic region of injury significantly influenced no-show rates (OR 6.61; 95% CI, 1.45 to 30.5), with patients with a spine or back complaint having the highest no-show rate. Follow-up rates were influenced by the orthopaedic resident provider consulted (OR 10.8; 95% CI, 4.11 to 31.1), and this was not related to level of training (p = 0.25). The type of bracing applied influenced the no-show rate (OR 2.46; 95% CI, 1.58 to 3.96), and the easier it was to remove the brace (splint), the worse the follow-up (p = 0.0001). Several demographic variables were also predictive of clinic nonattendance, including morbid obesity (OR 15.0; 95% CI, 4.83 to 51.6) and current tobacco use (OR 5.56; 95% CI, 2.19 to 15.4).

Conclusions: This study supports previous evidence of high no-show rates with scheduled orthopaedic follow-up among patients treated in the ED. The data highlight distinct orthopaedic-related factors associated with nonattendance. These findings are useful in identifying patients at high risk for no-show to scheduled orthopaedic follow-up appointments and may influence disposition and management decisions for these patients.

1University of North Carolina at Charlotte, Department of Biology, 9201 University City Boulevard, Woodward Hall, Charlotte, NC 28223. E-mail address: mcolem26@uncc.edu

2Baylor College of Medicine, Department of Emergency Medicine, 1504 Taub Loop, Houston, TX 77030

3Baylor College of Medicine, Department of Orthopaedic Surgery, 6620 Main Street, Suite 1324, Houston, TX 77030. E-mail address for C.A. Reitman: creitman@bcm.edu

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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