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Neurological status in paediatric upper limb injuries in the emergency department--current practice
James S Robertson1, Andrew G Marsh, James S Huntley
1Orthopaedic Department, Royal Hospital for Sick Children, University Glasgow, Yorkhill, Glasgow G3 8SJ, UK.
Insights
Emergency Department (ED) staff often fail to document neurological status in pediatric patients with upper limb injuries. This oversight means pre-operative neurological deficits are frequently missed, impacting patient care.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Emergency Medicine
Background:
- Assessing neurological injury is crucial in pediatric upper limb injuries.
- Initial assessment in the Emergency Department (ED) is key for timely diagnosis.
- Incomplete neurological documentation can lead to missed diagnoses.
Purpose of the Study:
- To evaluate the completeness of initial neurological status documentation in pediatric patients with upper limb injuries in the ED.
- To identify the prevalence of missed neurological deficits upon admission to the orthopedic ward.
Main Methods:
- Retrospective review of 121 pediatric patient case notes admitted to an orthopedic ward over three months.
- Analysis of initial ED documentation for neurological assessment.
- Comparison of ED records with orthopedic admission findings for neurological deficits.
Main Results:
- 88.4% of case notes included some neurological documentation.
- 11.6% of case notes lacked any mention of neurological examination.
- 10 patients (8.2%) had pre-operative neurological deficits, none identified by the ED.
Conclusions:
- Significant deficiencies exist in ED neurological documentation for pediatric upper limb injuries.
- This suggests a potential knowledge gap among ED staff regarding pediatric upper limb neurological examination.
- Improved ED assessment protocols are needed to ensure accurate documentation and identification of neurological deficits.
Background:
In upper limb injuries it is important to assess associated neurological injury. The aim of this study was to assess the initial (Emergency Department (ED)) documentation of neurological status in paediatric patients presenting with upper limb injuries.
Findings:
Case notes of paediatric patients admitted to the orthopaedic ward with upper limb injuries were retrospectively collected over a three month period. Initial ED documentation was recorded and case notes examined for any neurological deficit on admission. Of the 121 patients, 107 (88.4%) of case notes had some form of neurological documentation. The remaining case notes (n = 14, 11.6%) had no mention of neurological examination. There were 10 (8.2%) patients with pre-operative neurological deficits identified; none of these had been previously identified by the ED.
Conclusion:
There are failings of neurological documentation on the part of ED staff. It is likely that these reflect a knowledge deficit in the examination of the injured upper limb in paediatric patients.
