Urgent Care or Emergency Department for Childhood Injuries?
May 16, 2019
As the weather warms and kids head outdoors, the chance for injury rises. Where should families seek help when accidents occur? Minor mishaps can be treated at home or evaluated by your child’s primary care provider, but what about significant injuries or ones that occur after-hours? Should you head to a local urgent care or emergency department? The answer depends on the nature of your child’s injury and the services offered in your community.
Scrapes and Cuts
Simple scrapes and tiny cuts can be cared for at home. Wash the wound gently, pat dry, apply antibiotic ointment and watch for signs of infection, such as redness, swelling, drainage or fever. Larger cuts heal better (and with less risk for infection) when the wound is closed with stitches.
The reasons for stitching a wound include gaping edges or ones that pull apart easily, exposed tissue that is normally beneath the skin or persistent bleeding despite holding pressure. If stitches are needed, seek help as soon as possible for best results.
Most urgent care centers can stitch simple wounds without difficulty. However, when cuts are particularly large or deep, contain foreign objects or involve critical structures, such as eyelids, nose or ears, an emergency department may be better suited to handle the injury. If holding pressure does not stop bleeding after a few minutes, call 911.
Also remember that any size wound can be a risk for tetanus, especially ones that happen outside. Even if you don’t think a cut needs stitches, seek help if your child’s immunizations are not up to date.
Arms and Legs
Sprains and strains can usually be treated at home or by your primary care provider. However, pain that is severe or does not get better with rest, could be a broken bone. X-rays are needed to make this diagnosis. Most urgent care centers can take x-rays and apply splints if a simple break is detected. If a cast is needed, this is usually applied when you follow-up with a bone doctor a few days later.
Broken bones are best treated in an emergency department if an arm or leg appears crooked or when bone is poking through the skin. If you are seen in an urgent care and x-rays reveal a broken bone that is not lined up correctly, you may be sent to an emergency department for sedation medicine and a procedure to set the bone straight again.
Head and Neck
Head and neck injuries are common in kids. If there is neck pain after a high impact collision or fall, keep your child still and call 911 immediately. Head injuries should be seen in an emergency department if there is loss of consciousness, severe headache, persistent vomiting or confusion.
Head injuries with mild to moderate headache, dizziness, decreased energy or subtle personality change usually indicate concussion. These can be seen in an urgent care, but if there are concerning findings on the neurological exam, your child will likely be sent to an emergency department for further evaluation.
Minor burns with red skin (first degree) or a small blister (second degree) can be cared for at home. Gently wash the wound, pat dry and apply antibiotic ointment for a few days. Allow blisters to open on their own and provide acetaminophen or ibuprofen for pain. If signs of infection appear (increasing redness, swelling, drainage or fever), call your doctor right away.
Small burns with big blisters can be seen and treated in an urgent care. Burns larger than your child’s palm and those involving the face or joints are best suited for an emergency department. Burns of any size with a black or pale appearance and numb skin (third degree) should be seen in an ER.
When deciding which urgent care or emergency department to use, a few additional considerations are in order.
Emergency departments are equipped and staffed to handle any emergency. Urgent cares provide fewer services, and the services provided may vary widely between locations. Most offer simple x-rays, common lab tests and primary care physicians. However, they are unable to provide advanced imaging, such as CAT scans or ultrasounds, advanced lab tests or specialists, like bone doctors or surgeons.
You’ve heard the adage that children are not little adults. It’s true! Children require smaller equipment and devices, different doses and special expertise. Choose a pediatric-specific urgent care or emergency department when these are available.
It’s best to be prepared BEFORE an injury or emergency takes place. Ask your child’s provider where to go when an accident happens or the office is closed. They know the resources available in your community and will steer you in the right direction.
Dr Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.
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