What should be documented for an anterior shoulder dislocation? A Delphi study

Area of Science:

• Emergency Medicine
• Orthopaedic Surgery
• Clinical Documentation Standards

Background:

• Standardized documentation for anterior shoulder dislocation in the emergency department (ED) is needed to improve clinical quality and research consistency.
• Current ED documentation practices for shoulder dislocations exhibit heterogeneity, impacting clinical care and research.

Purpose of the Study:

• To identify essential elements for ED documentation of anterior shoulder dislocation.
• To assess the extent of variability in expert opinion regarding these documentation elements.

Main Methods:

• A three-round Delphi study involving emergency physicians, orthopaedic surgeons, and general practitioners.
• Experts rated the importance of 85 identified documentation elements using a 0-9 Likert scale.
• Consensus was defined as ≥80% scoring 7-9; high variability was defined as scores between 1-3 and 7-9.

Main Results:

• Consensus was achieved on 22 out of 85 elements across history, physical examination, additional examinations, reduction, and miscellaneous categories.
• Despite consensus on some elements, high variability (93%) was observed in the importance ratings of almost all items after the third round.
• The expert panel comprised 22 emergency physicians, 5 general practitioners, and 3 orthopaedic surgeons.

Conclusions:

• A core set of 22 elements for anterior shoulder dislocation documentation in the ED was identified through expert consensus.
• Significant variability in expert opinion remains, underscoring the need for standardized protocols.
• These consensus elements can improve communication and facilitate homogenous datasets for future research.