Tertiary Care Referrals for Fractures in Children

Purpose: With limited local access to pediatric subspecialty care outside major metropolitan areas, tertiary care hospitals treat many children originally seen at outside facilities for relatively brief but urgent surgical procedures. This referral-based care imposes significant financial and psychological stress on the families. Design: Prospective, survey methodology was used. Methods: Families of children aged 0-18 years admitted to the St. Louis Children's Hospital for surgical repair of fractures were surveyed. The questionnaire was developed by the research team and measured a variety of fields. Findings: The operative procedure in the majority of these children was relatively brief in both groups, often less than one hour. The time of injury to their discharge from our hospital, however, extended to 36 hours. Families missed several days of work. Many children were kept NPO longer than needed. Conclusions: Our preliminary evaluation suggests that a relatively minor unexpected surgery of a child can impose significant financial, organizational, and psychological burden on the family.