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Sedation for Forearm Fracture Reduction in the Pediatric Emergency Department: Impact on Hospitalization and Length

Maali Abu-Omer1, Gilad Chayen2, Ron Jacob3

  • 1Department of Pediatrics B, Emek Medical Center, Afula, Israel.

The Israel Medical Association Journal : IMAJ
|May 2, 2023
PubMed

Insights

Pediatric patients with forearm fractures requiring closed reduction had significantly lower hospitalization rates when treated in a pediatric emergency department (PED) with sedation compared to a general trauma emergency department (GTED). While length of stay was longer in the PED, the reduction in hospital admissions was substantial.

Area of Science:

  • Pediatric Emergency Medicine
  • Orthopedic Trauma
  • Patient Care Management

Background:

  • Children with forearm fractures often require closed reduction in the emergency department (ED).
  • Historically, pediatric trauma patients were treated in a general trauma ED (GTED) without dedicated sedation services.
  • Transition to a pediatric ED (PED) with sedation services aimed to improve care for these fractures.

Purpose of the Study:

  • To compare hospitalization rates and length of stay (LOS) for pediatric forearm fracture reductions.
  • Evaluate the impact of treatment location (GTED vs. PED) on patient outcomes.
  • Assess the effectiveness of sedation in the PED for closed fracture reductions.

Main Methods:

  • Retrospective observational study at a regional hospital.
  • Included patients under 18 with forearm fractures needing closed reduction.
  • Primary outcome: hospitalization rate; Secondary outcome: ED length of stay (LOS).

Main Results:

  • 165 patients analyzed (79 GTED, 96 PED).
  • Hospitalization rates were significantly lower in the PED with sedation (6.3%) versus GTED (21.5%).
  • Median ED LOS was longer in the PED (237 minutes) compared to GTED (168 minutes).

Conclusions:

  • Sedation in the PED for forearm fracture reduction more than tripled the decrease in hospitalization rates.
  • Despite increased resource needs, the PED approach resulted in only a mild increase in ED LOS.
  • The findings support the use of sedation in a dedicated PED for pediatric forearm fracture management.
Abstract

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