Purpose Emergency departments (ED) and urgent care centers (UCC) are often the first line in diagnosing and managing acute pediatric orthopaedic injuries. The purpose of this study was to assess the diagnoses patients receive from emergency departments and urgent care center visits to see if there was agreement with the pediatric orthopaedic surgeon. Methods All patients who presented for an initial injury evaluation after being seen in an urgent care center or outside emergency department were prospectively recruited. Patients who were not given official documentation detailing their injury were excluded. A blinded comparison was made between the official discharge diagnosis from the ED/UCC and the diagnosis made at the evaluation by the pediatric orthopaedic surgeon. Simple statistics were performed. Results 207 patients were enrolled in this study. 160 patients were treated for upper extremity and 47 patients for lower extremity injuries. The overall correct diagnosis rate from the ED and UCC for all injuries was 65% (135/207). For the upper extremity, 100 patients were triaged in emergency departments and 60 in urgent care centers. Emergency departments diagnosed acute pediatric upper extremity injuries correctly in 71% (71/100) of patients in comparison to 57% (34/60) in urgent care centers. Common missed diagnoses include Salter Harris I fractures of the hand, wrist and elbow and misdiagnosing fractures as ligamentous sprains or contusions. 38 % (21/55) of the incorrect diagnoses occurred in multiple bone injuries when a component of the injury was missed (i.e. missed radial neck fracture with concomitant wrist injury, radius or ulna of both bone fractures, monteggia variant). For the lower extremity, 28 patients were triaged in emergency departments and 19 in urgent care centers. Emergency departments diagnosed acute pediatric lower extremity injuries correctly in 57% (16/28) of patients in comparison to 74% (14/19) in urgent care centers. Common incorrect diagnoses include misdiagnosing patellofemoral syndrome as a knee sprain or fracture and misdiagnosing ankle fractures as ligament sprains. 29% (5/17) of the incorrect diagnoses occurred in multiple bone injuries when a component of the injury was missed (i.e. tibial or fibular component of bimalleolar fractures). Conclusion Emergency departments and urgent care center diagnoses of acute pediatric orthopaedic injuries are only accurate 65% of the time. Urgent care and emergency department providers need better education in order to improve the accuracy of diagnosing these injuries and therefore provide the appropriate treatment and counseling.