1569 Paediatric Upper Limb Fracture Manipulation in A Children's Emergency Department: Practice Changes During The COVID-19 Pandemic. (12th October 2021)

• Record Type: Journal Article
• Authors: Derias, M; Amen, J; Morrissey, N; Alexander-Harvey, G; Porter, J; James, Kyle; Crompton, T; Maripuri, S
• Is Part Of: British journal of surgery. Volume 108:Supplement 6(2021)
• Publication Date: 2021-10-12
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab259.510
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Trauma theatre time is valuable and previous studies reported cost of £24.77/minute. BSUH Children's emergency department (CED) guidelines were implemented in December 2016, allowing reduction of forearm and distal radius (DR) fractures in CED using 70% nitrous (N2 O) sedation. Due to COVID-19 pandemic and the risks associated with aerosol generating procedures as well as staffing levels, CED shifted to using 50%N2 O with or without intranasal fentanyl. Method: Relevant fractures presenting to CED from Feb-Dec 2020 were identified and compared to previous years. Demographics, treatment modality, timings, and outcomes were reviewed for 275 patients. Results: In 2017-2018, 56% were manipulated in CED under 70%N2 O (compared to only 3% in 2016). The main barrier identified was shortage of doctors trained in sedation to supervise use of 70%N2 0. In 2020, 101 patients were suitable for manipulation in CED. 64 had DR fractures, 37 midshaft fractures, 65 were male. Mean age: 10 years. 92 patients (91%) were manipulated in CED/fracture clinic. One was under 70%N2 O; the rest used 50%N2 O with or without intranasal fentanyl. 8 (9%) had manipulation under GA. Of those manipulated in CED, 3 were re-manipulated in clinic for cast problems. A typical MUA takes 30minutes indicating a saving of £743 per case; therefore, £68, 356 over the study period. Conclusions: Paediatric upper limb fracture manipulation in CED under N2 O is effective and provides significant cost savings. Due to changes related to COVID-19 pandemic, considerably more patients in 2020 were safely treated in CED/clinic. Using 50%N2 O improves uptake due to lower staffing requirements.