{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:26:03Z","timestamp":1787671563380,"version":"build-2736575974"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["J Am Acad Orthop Surg","JAAOS"],"published-print":{"date-parts":[[2023,9,15]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Foot and ankle fractures are common injuries for which patients may need urgent evaluation and care. Many such injuries are managed in emergency departments (EDs), but urgent care facilities may sometimes be an appropriate setting. Understanding which foot and ankle fractures are managed at which facility might help define care algorithms, improve patient experience, and suggest directions for containing costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective cohort study used the 2010 to 2020 M151 PearlDiver administrative database. Adult patients less than 65 years old presenting to EDs and urgent care facilities for foot and ankle fractures were identified using ICD-9 and ICD-10 diagnosis codes, excluding polytrauma, and Medicare patients. Patient\/injury variables associated with urgent care utilization relative to ED utilization and utilization trends of urgent care relative to ED were assessed with univariable and multivariable analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From 2010 to 2020, 1,120,422 patients with isolated foot and ankle fractures presented to EDs and urgent care facilities. Urgent care visits evolved from 2.2% in 2010 to 4.4% in 2020 (P , 0.0001). Independent predictors of urgent care relative to ED utilization were defined. In decreasing odds ratios (ORs), these were insurance (relative to Medicaid, commercial OR 8.03), geographic region (relative to Midwest, Northeast OR 3.55, South OR 1.74, West OR 1.06), anatomic location of fracture (relative to ankle, forefoot OR 3.45, midfoot 2.20, hindfoot 1.63), closed fracture (OR 2.20), female sex (OR 1.29), lower ECI (OR 1.11 per unit decrease), and younger age (OR 1.08 per decade decrease) (P , 0.0001 for all).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>A small but increasing minority of patients with foot and ankle fractures are managed in urgent care facilities relative to EDs. While patients with certain injury types were associated with increased odds of urgent care relative to ED utilization, the greatest predictors were nonclinical, such as geographic regions and insurance type, suggesting areas for optimizing access to certain care pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>III<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5435\/jaaos-d-22-01097","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T17:02:34Z","timestamp":1685466154000},"page":"984-989","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Urgent Care Versus Emergency Department Utilization for Foot and Ankle Fractures"],"prefix":"10.5435","volume":"31","author":[{"given":"Meera M.","family":"Dhodapkar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Gouzoulis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott J.","family":"Halperin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell","family":"Modrak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad J.","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2626-7278","authenticated-orcid":false,"given":"Jonathan N.","family":"Grauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"R1-20250503","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1053\/j.jfas.2019.09.016","article-title":"Ankle fracture epidemiology in the United States: Patient-related trends and mechanisms of injury","volume":"59","author":"Scheer","year":"2020","journal-title":"J Foot Ankle Surg"},{"key":"R2-20250503","doi-asserted-by":"crossref","first-page":"539","DOI":"10.3109\/17453678709146395","article-title":"Epidemiology of ankle fractures in Rochester, Minnesota","volume":"58","author":"Daly","year":"1987","journal-title":"Acta Orthop Scand"},{"key":"R3-20250503","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1186\/s12891-018-2326-x","article-title":"Epidemiology of adult ankle fractures: 1756 cases identified in norrbotten county during 2009-2013 and classified according to AO\/OTA","volume":"19","author":"Juto","year":"2018","journal-title":"BMC Musculoskelet Disord"},{"key":"R4-20250503","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.fas.2016.11.002","article-title":"Population-based epidemiology of 9767 ankle fractures","volume":"24","author":"Elsoe","year":"2018","journal-title":"Foot Ankle Surg"},{"key":"R5-20250503","doi-asserted-by":"crossref","first-page":"e049543","DOI":"10.1136\/bmjopen-2021-049543","article-title":"Root causes and preventability of emergency department presentations of older patients: A prospective observational study","volume":"11","author":"Driesen","year":"2021","journal-title":"BMJ Open"},{"key":"R6-20250503","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/1735-1995.200277","article-title":"Overcrowding in emergency departments: A review of strategies to decrease future challenges","volume":"22","author":"Yarmohammadian","year":"2017","journal-title":"J Res Med Sci"},{"key":"R7-20250503","first-page":"1","article-title":"Wait time for treatment in hospital emergency departments: 2009","author":"Hing","year":"2012","journal-title":"NCHS Data Brief"},{"key":"R8-20250503","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.ajem.2013.12.047","article-title":"Setting wait times to achieve targeted left-without-being-seen rates","volume":"32","author":"Lucas","year":"2014","journal-title":"Am J Emerg Med"},{"key":"R9-20250503","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1080\/07359683.2017.1307066","article-title":"The relationship between emergency department wait times and inpatient satisfaction","volume":"34","author":"Davenport","year":"2017","journal-title":"Health Marketing Q"},{"key":"R10-20250503","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.annemergmed.2016.12.006","article-title":"Comparing utilization and costs of care in freestanding emergency departments, hospital emergency departments, and urgent care centers","volume":"70","author":"Ho","year":"2017","journal-title":"Ann Emerg Med"},{"key":"R12-20250503","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1001\/jamainternmed.2018.3205","article-title":"Trends in visits to acute care venues for treatment of low-acuity conditions in the United States from 2008 to 2015","volume":"178","author":"Poon","year":"2018","journal-title":"JAMA Intern Med"},{"key":"R13-20250503","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1472-6963-9-79","article-title":"Urgent care centers in the U.S.: Findings from a national survey","volume":"9","author":"Weinick","year":"2009","journal-title":"BMC Health Serv Res"},{"key":"R14-20250503","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1377\/hlthaff.2009.0748","article-title":"Many emergency department visits could be managed at urgent care centers and retail clinics","volume":"29","author":"Weinick","year":"2010","journal-title":"Health Aff"},{"key":"R15-20250503","first-page":"100122","article-title":"Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion","volume":"10","author":"Kammien","year":"2022","journal-title":"North Am Spine Soc J"},{"key":"R16-20250503","doi-asserted-by":"crossref","first-page":"232596712210835","DOI":"10.1177\/23259671221083586","article-title":"Emergency department visits within 90 Days of anterior cruciate ligament reconstruction","volume":"10","author":"Kammien","year":"2022","journal-title":"Orthopaedic J Sports Med"},{"key":"R17-20250503","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/1475-6773.13631","article-title":"The impact of urgent care centers on nonemergent emergency department visits","volume":"56","author":"Allen","year":"2021","journal-title":"Health Serv Res"},{"key":"R18-20250503","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1377\/hlthaff.2020.01869","article-title":"Urgent care centers deter some emergency department visits but, on net, increase spending","volume":"40","author":"Wang","year":"2021","journal-title":"Health Aff"},{"key":"R19-20250503","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.annemergmed.2019.06.024","article-title":"Impact of urgent care openings on emergency department visits to two academic medical centers within an integrated health care system","volume":"75","author":"Carlson","year":"2020","journal-title":"Ann Emerg Med"},{"key":"R20-20250503","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1097\/CORR.0000000000001825","article-title":"Musculoskeletal urgent care centers restrict access for patients with Medicaid insurance based on policy and location","volume":"479","author":"Yousman","year":"2021","journal-title":"Clin Orthop Relat Res"},{"key":"R21-20250503","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1177\/1071100713500656","article-title":"Outcome of nonoperative management of displaced oblique spiral fractures of the fifth metatarsal shaft","volume":"34","author":"Aynardi","year":"2013","journal-title":"Foot Ankle Int"},{"key":"R22-20250503","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s00402-010-1164-6","article-title":"Demographics and outcome of metatarsal fractures","volume":"131","author":"Cakir","year":"2011","journal-title":"Arch Orthop Trauma Surg"},{"key":"R23-20250503","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1111\/acem.13220","article-title":"Why do people choose emergency and urgent care services? A rapid review utilizing a systematic literature search and narrative synthesis","volume":"24","author":"Coster","year":"2017","journal-title":"Acad Emerg Med"}],"container-title":["Journal of the American Academy of Orthopaedic Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-22-01097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:46:08Z","timestamp":1787669168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-22-01097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,11]]},"references-count":22,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.5435\/jaaos-d-22-01097","relation":{},"ISSN":["1067-151X","1940-5480"],"issn-type":[{"value":"1067-151X","type":"print"},{"value":"1940-5480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,11]]},"assertion":[{"value":"2022-11-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}