A Quality Improvement Initiative of Standard 1 of the British Orthopaedic Association Standards for Trauma (BOAST) for Management of Supracondylar Fractures in Children.

BACKGROUND

Supracondylar humeral fractures are the most common elbow injuries in children and carry a high risk of neurovascular compromise. The British Orthopaedic Association Standards for Trauma (BOAST) recommend thorough documentation of vascular and nerve assessment in every case.

OBJECTIVE

To evaluate compliance with BOAST Standard 1 for neurovascular documentation in paediatric supracondylar fractures at a large NHS hospital trust.

METHODS

A retrospective cohort audit of 44 patients between January and May 2022 was performed. Neurovascular documentation, imaging practices, and adherence to BOAST criteria were assessed from e-Trauma and PACS (Picture Archiving and Communication System) records. Statistical analysis was carried out using IBM SPSS Statistics for Windows, version 24 (IBM Corp., Armonk, NY, USA).

RESULTS

Forty-four paediatric patients with supracondylar fractures were included (mean age 7.4 years, 61% male). Extension-type fractures accounted for 93%, with Gartland Types I, II, and III representing 30% (n=13), 43% (n=19), and 27% (n=12), respectively. Only 10% (n=4) of patients had detailed nerve function documented, while 40 (90%) were recorded as "neurovascular intact." Radial artery status was missing in 25 (57%) cases, and capillary refill time was not recorded in 14 (32%). Post-cast X-rays were obtained in 29 (66%) patients, but 12 (28%) were discharged in a cast without imaging. Overall, compliance with BOAST Standard 1 was poor.

CONCLUSION

Compliance with BOAST Standard 1 was poor, especially in the documentation of nerve and vascular status. This represents a significant patient safety concern. Educational interventions and structured proformas are required to improve adherence and should be followed by re-audit.