Manipulation of simple paediatric forearm fractures: a time-based comparison of emergency department sedation with theatre-based anaesthesia

Abstract

Aim: Procedural sedation has become widespread in emergency departments (ED) worldwide due to the ability to perform short turnaround noxious procedures beyond the confines of the operating theatre. We report one institution's experience with paediatric forearm fracture reduction and compare key time-based metrics for ED manipulation under procedural sedation (MUS), with traditional theatre-based manipulation under anaesthesia (MUA).

Method: All simple paediatric forearm fractures requiring manipulation before casting at Waikato hospital during the 2009 calendar year were studied. Time from presentation to fracture manipulation, procedure room occupancy, and hospital length of stay were recorded. Requirement for repeated intervention was additionally collated.

Results: Of 385 patients presenting with forearm fracture 108 underwent MUS and 66 MUA. Time to manipulation was shorter in the MUS group (58 plus or minus 38 minutes MUS vs. 558 plus or minus 368 minutes MUA; p<0.0001), as was hospital length of stay (139 plus or minus 70 minutes MUS vs 1452 plus or minus 544 minutes MUA; p<0.0001). No difference was observed in requirement for repeated intervention between groups (15% MUS vs 21% MUA; p=0.305).

Conclusion: Manipulation of simple closed paediatric forearm fractures under procedural sedation was associated with lesser delay to reduction, and shorter hospital length of stay, compared with traditional manipulation under anaesthesia in the operating theatre.