Objective: We sought to examine variables associated with Emergency Department (ED) revisits
due to cast-related symptoms (CRS) in children with non-torus forearm fractures (NTFF).
Design: A retrospective cohort study.
Setting: Level one trauma center.
Patients/Participants: ED children who were treated with cast immobilization for NTFF between
January 2011 and December 2017.
Intervention: Patient demographics, location of fracture, type of casting (below elbow/above
elbow), pain scores on first visit, treatment with fracture reduction, and revisit data were collected.
Multivariate logistic regression was used to identify predictors of ED revisits due to CRS, within 72
hours after discharge.
Main Outcome Measurements: Presence of at least one of the following symptoms: pain/discomfort
around the cast area, swelling, color change, skin irritation.
Results: A total of 2,307 children with NTFF with a mean age of 9.6±3.8 years were treated with
cast immobilization. One hundred and fifty-three (6.7%) patients had ED revisits due to CRS, 95
(62.1%) of which were painful (median pain score 7, interquartile range 5-9). No patient had
neurovascular compromise, or required surgery or re-reduction. Variables on first visit that were
associated with increased odds for revisit included treatment with fracture reduction [odds ratio
(OR) 2.31, 95% confidence interval (CI) 1.58-3.36] and a median pain score of 6 or more on
admission [OR=1.57, 95% CI 1.32-2.13].
Conclusions: The findings suggest that treatment with fracture reduction and higher pain scores on
admission were independently associated with ED revisit due to CRS. A considerable amount of
children with CRS are painful.
Level of Evidence: III, retrospective cohort study
