What are common presentations in the Emergency Room (ER) minor clinic?

Common Presentations in the ER Minor Clinic

Minor injury clinics in emergency departments primarily manage sprains/strains, lacerations, contusions/abrasions, and fractures, with distinct patterns between age groups—younger adults predominantly present with soft tissue injuries while older adults more commonly present with fractures. 1

Most Common Minor Injury Presentations

Overall Injury Patterns

• Sprains and strains represent the most frequent presentation in younger adults (36% of minor injuries) 1
• Lacerations requiring suturing are among the most common presentations managed by both physicians and nurse practitioners 2, 3
• Contusions and abrasions constitute a significant proportion of minor trauma presentations 1, 4
• Fractures (excluding hip/femur) are common, particularly in older adults where they represent 32% of minor injury presentations 1

Age-Specific Patterns

Pediatric Presentations:

• Fever and respiratory illnesses are the leading complaints in children under 5 years, particularly those under 2 years 5
• Minor trauma including sprains, lacerations, and contusions are common in older children 4
• Acute otitis media frequently presents in infants and toddlers, often with fever 5
• Dehydration from gastroenteritis represents a common reason for emergency care in young children 5

Adolescent Presentations:

• Headache and sore throat are frequent complaints in teenagers, often requiring assessment for serious underlying causes 6
• Minor musculoskeletal injuries from sports and recreational activities 4

Older Adult Presentations (≥65 years):

• Fractures are the predominant injury pattern (32% of presentations), significantly higher than younger adults 1
• Falls represent a major mechanism requiring systematic assessment 7
• Older adults with minor injuries have 25% admission rates compared to only 5% in younger adults, indicating higher complexity despite "minor" classification 1

Clinical Characteristics and Triage Considerations

Acuity and Resource Utilization

• Older adults with minor injuries receive proportionately higher triage categories than younger adults with similar injuries 1
• Mean length of stay for older adults with minor injuries is 315 minutes versus 198 minutes for younger adults—a clinically significant difference 1
• Only 73% of older adults are discharged home compared to 92% of younger adults with minor injuries 1

Pain Management Gaps

• Pain assessment is documented in only 57.5% of pediatric minor injury presentations, with site variability ranging from 1.4% to 100% 4
• Pain reassessment occurs in only 3.5% of cases, even among patients presenting with severe pain (scores 7-10) 4
• 21% of patients receive prehospital analgesia before ED arrival 4

Common Pitfalls and Clinical Considerations

Diagnostic Accuracy Issues

• Erythema multiforme is frequently misdiagnosed in pediatric patients, with urticaria multiforme being the most common misdiagnosis (20 of 48 misdiagnosed cases) 8
• Distinguishing between viral and bacterial causes of fever remains challenging in infants and young children 5

Infection Control in Ambulatory Settings

• Patients with respiratory symptoms or rashes should be identified during scheduling and triaged to avoid waiting room exposure 7
• Respiratory hygiene/cough etiquette should be implemented with signage and supplies available 7
• Symptomatic children should be segregated from well children as quickly as possible 7

Special Populations Requiring Enhanced Assessment

• Infants under 3 months with fever require special consideration and lower threshold for intervention 5
• Children with chronic medical conditions have 2-fold increased risk of return visits 5
• Older adults presenting with any minor injury warrant comprehensive assessment including fall risk, cognitive screening, and medication review 7, 1

Nurse Practitioner Role in Minor Injury Management

• Nurse practitioners provide equivalent or superior care compared to junior doctors for minor injuries, with clinically important error rates of 9.2% versus 10.7% respectively 2
• Nurse practitioners demonstrate better documentation of medical history and patients have fewer unplanned follow-up visits 2
• Suturing by clinical nurse specialists produces similar wound healing outcomes with higher patient satisfaction compared to medical staff 3