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Paediatric distal radial fracture manipulation: multicentre analysis of process times
L Mitchell1, E Archer, S Middleton
1Emergency Department, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK.
Insights
Children with radial fractures wait over 8 hours for anesthesia and 21 hours for discharge. Procedural sedation in the emergency department (ED) offers a faster alternative for pediatric patients.
Area of Science:
- Pediatric Orthopedics
- Emergency Medicine
- Anesthesiology
Background:
- Children with simple radial fractures typically require manipulation under general anesthesia.
- Hospital admission is conventional for this procedure.
- This study explores patient experience, assuming a desire for minimal hospital stays.
Purpose of the Study:
- To evaluate the experience of children with distal radial fractures undergoing manipulation under general anesthesia.
- To assess the feasibility of alternative sedation methods in the emergency department.
Main Methods:
- Retrospective analysis of patient data from three hospitals in South West England.
- Examined time from emergency department (ED) arrival to general anesthesia.
- Tracked time from ED arrival to hospital discharge.
Main Results:
- Median wait time for general anesthesia exceeded 8 hours.
- Median time from ED admission to discharge was over 21 hours.
- Paediatric procedural sedation in the ED at one hospital averaged 4-5 hours from arrival to discharge.
Conclusions:
- Current general anesthesia protocols lead to prolonged hospital stays for children with radial fractures.
- Procedural sedation in the ED presents a viable alternative.
- Implementing procedural sedation could significantly reduce patient turnaround time.
Background:
Children with simple radial fractures requiring manipulation are conventionally admitted for manipulation under general anaesthesia. On the assumption that children (and their parents) wish to spend as little time in hospital as possible, a study was undertaken to explore the experience of children with distal radial fractures admitted for general anaesthesia.
Methods:
A retrospective analysis was performed of the time taken from arrival at the emergency department (ED) to general anaesthesia and the time taken from arrival at the ED to hospital discharge in three centres in south-west England: the Bristol Children's Hospital, Derriford (Plymouth) Hospital and the Royal Devon & Exeter Hospital.
Results:
The median wait for general anaesthesia was >8 h and the median wait from ED admission to discharge was >21 h. This compares with a typical arrival to discharge time for paediatric procedural sedation of 4-5 h in the ED of the Royal Devon & Exeter Hospital.
Conclusions:
Given the assumption that children (and their parents) wish to spend as little time in hospital as possible, there appears to be a role for procedural sedation in the ED for this group of children, with a significantly reduced turnaround time anticipated.
