The Children's Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED) project : a national prospective trainee-led collaborative audit of practice.
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Gourbault Lysander J, Whitham Robert, Womersley Andrew, Jones Erin, Christie Alexander, Duggleby Luke, Atherton William Guy, CURFFED Collaborative, Doughty Ben, Smith Isabella, Hassan Abdul Rahman, Levitt Will, Davies Angharad, Carpenter Charlotte, Saltanat Shahtajarab, Buddhdev Pranai, Lennox-Warburton Hannah, Donnelly Eoghan, Kim Kate, Farooq Jowad, Dean Claire Spolton, Edwards Caroline, Mahmoud Mohamed, Stone Andrew, Oyekan Adekinte, Jalgaonkar Azal, To Christopher, Hunt Alex, Garner Madeleine, Campion Alice, Sison Megan, Irby Sarah, Price Michael, Sharoff Lokesh, Worley Rebecca, Tahir Hyder, Bircher Andrew, Modi Nitin, Theobald Emma, Genena Ahmed, Carter Daniel, Milnes Lydia, Roberts Tobias, Vasudev Ashish, Green Dylan, Boucher Alexander, Caruana Ethan, Khokhar Omar, Kumar Prem, Rahman Hamza, Seewoonarain Sheena, Thumbadoo Ruben, Forster Sophie, Vadivelu Ramanan, Bagshaw Lorna, Varghese Bobin, Thalanki Srikiran, Franco Aubrey Conrad, Hamid Laveeza, Liew Ignatius, Robinson Jordon, Gurung Ishani, Figg Peter, Moverley Rob, Neal-Smith Greg, Barot Kunjan, Oo Thet Paing, Hanger Joseph, Larsen Matthew, Jones Alice, Lougher Laura, Flintoft-Burt Matthew, Dellis Spilios, Kamal Tamer, Bajaj Sunil, Chema Kamalpreet, Lebe Moritz, Bhandari Gaurav, Jeans Edward, James Kyle, Barrow Tom, Fernandez Leticia, Razemba Takura, Hawkins Russell, Anderson Kerry, Tillotson Laura, Thomas William, Burden Eleanor, Kadambande Sujit, Ibrahim Ibrahim Khalil, O'Boyle Mannix, McCormack Louise, O'Donnell Janine, Baird Emily, MacDonald Fiona, Aithie Joanna, Robinson Patrick, Esland Joe, Keightley Andrew, Jain Aman, Thakker Dev, Nayak Mayur, Caamina Leticia, Barrow Tom, Discalicau David, Lockton Zoe, Burgan Amjad, Morris Greg, Bansal Rajeev, Sinha Maneesh, Mostafa Omar, Ishaq Usman, Elmorsy Ahmed, Thomas Alex, Ross Portia, Theivendran Kanthan, Khaleeq Tahir, Lindisfarne Edward, Gangadharan Rohit, Thiruchandran Gajendiran, Youssef Khaled, Tober Andrzej, Shah Nirav, Varasteh Amir, Bajracharya Abhijit, Lashin Ahmed, Mifsud Max, Lloyd Thomas, Kirk Christian, Ball Thomas, Sheen Jonathan, Kapoor Smriti, Jones Iolo Thomas, Donnachie Douglas, Clamp Kelly, Westacott Dan, Miller James, Hedge Elizabeth, Gomindes Austin, Amour Lisa, Ibrahim Jaffar, Dwyer Jonathan, Bickley Madeleine, Fulcher Emily, Chourasia Ajay Kumar, Hosny Sherif, Hashem Mohamed, Dutta Agneish, Leong Darren, Fergurson Kim, Haddock Amy, Malik Minaal, Varasteh Amir, Cruz Louise, Jenkins Lydia, East Jamie, Oxley Charlie
Аннотация
METHODS: This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital.
RESULTS: Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge.
CONCLUSION: This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.