Nurses Offer Quicker Fix for Radial-Head Subluxation in Children

By David Douglas

April 24, 2014

NEW YORK (Reuters Health) - Although nurses aren't as good as physicians in emergency department reduction of radial-head subluxation in children, there's less of a wait, and in high-volume settings it's a useful skill, according to Canadian researchers.

As Dr. Andrew Dixon told Reuters Health by email, "The protocol is most applicable to children's hospitals, or at least to those emergency departments that see a large number of children, as the volume of these patients would not be sufficient to warrant the training of nurses in smaller sites. At these larger hospitals the primary benefits are twofold. Firstly children with a painful injury can be quickly treated with resolution of their pain. Secondly we can relieve the distress of families in a more timely manner."

In a March 24th online paper in CMAJ, Dr. Dixon of the University of Alberta, Edmonton and colleagues note that the injury is easily identified and treated but it's not clear whether trained triage nurses can do as well as physicians in performing the procedure.

To investigate, the researchers used a computer-generated randomization calendar which scheduled nurse-initiated or physician-initiated treatment days. Children aged six years or less who had a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours were treated accordingly.

In all, 245 children were included in the final analysis. In the nurse-assigned group, 105 of 124 (84.7%) had a successful subluxation. However, 117 of the 121 in the physician group (96.7%) did so.

The difference (12%) was such that the pre-specified non-inferiority margin of 10% was not achieved. However, the proportion of success was substantial in the nurse group and these children had a statistically and clinically significantly shorter overall length of stay in the emergency department. The median was 50 minutes in the nurse group and 105 minutes in the physician group.

The time element is of particular importance, Dr. Dixon said.

"Parents are often very stressed by this injury as they are usually the ones to cause the injury," he said. "Quick treatment can resolve this emotional distress in addition to the physical suffering of the child."

"There are trade-offs however," he concluded. "The nurses are not quite as good at the treatment as physicians. So as I see it, this study gives parents the choice between an immediate treatment that works 17/20 versus a delayed treatment that works 19/20."


CMAJ 2014.


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