Are Emergency Department Visits Missed Opportunities for Secondary Diagnosis?

Abstract

A 3-month-old girl, with a history of breech presentation, was brought to the Emergency Department (ED) after she fell from her father's lap. The fall caused traction of her left lower limb and resulted in pain and decreased mobility. At the ED she was observed by two specialties: pediatrics and orthopedics. Her lower left limb was flexed and in abduction, with normal passive movement and limited active movement. There was no limited abduction of the hip and the Ortolani reduction test was negative. Limb length discrepancy was absent. A hip radiograph was performed. There were no radiological signs of fracture or subluxation of the left hip. The child was admitted and remained in the observation room (OR) for 24 hours for close monitoring and pain relief. She was then discharged and referred to an Orthopedics consultation for follow up.