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Research

Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial

Andrew Dixon, Chantalle Clarkin, Nick Barrowman, Rhonda Correll, Martin H. Osmond and Amy C. Plint
CMAJ June 10, 2014 186 (9) E317-E323; DOI: https://doi.org/10.1503/cmaj.131101
Andrew Dixon
Department of Pediatrics (Dixon), University of Alberta; Stollery Children’s Hospital (Dixon), Edmonton, Alta.; Clinical Research Unit (Barrowman), Children’s Hospital of Eastern Ontario Research Institute; Children’s Hospital of Eastern Ontario Research Institute (Clarkin, Correll, Osmond, Plint), Ottawa, Ont.; Department of Pediatrics and Emergency Medicine (Osmond, Plint), University of Ottawa, Ottawa, Ont.
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  • For correspondence: Andrew.Dixon@AlbertaHealthServices.ca
Chantalle Clarkin
Department of Pediatrics (Dixon), University of Alberta; Stollery Children’s Hospital (Dixon), Edmonton, Alta.; Clinical Research Unit (Barrowman), Children’s Hospital of Eastern Ontario Research Institute; Children’s Hospital of Eastern Ontario Research Institute (Clarkin, Correll, Osmond, Plint), Ottawa, Ont.; Department of Pediatrics and Emergency Medicine (Osmond, Plint), University of Ottawa, Ottawa, Ont.
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Nick Barrowman
Department of Pediatrics (Dixon), University of Alberta; Stollery Children’s Hospital (Dixon), Edmonton, Alta.; Clinical Research Unit (Barrowman), Children’s Hospital of Eastern Ontario Research Institute; Children’s Hospital of Eastern Ontario Research Institute (Clarkin, Correll, Osmond, Plint), Ottawa, Ont.; Department of Pediatrics and Emergency Medicine (Osmond, Plint), University of Ottawa, Ottawa, Ont.
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Rhonda Correll
Department of Pediatrics (Dixon), University of Alberta; Stollery Children’s Hospital (Dixon), Edmonton, Alta.; Clinical Research Unit (Barrowman), Children’s Hospital of Eastern Ontario Research Institute; Children’s Hospital of Eastern Ontario Research Institute (Clarkin, Correll, Osmond, Plint), Ottawa, Ont.; Department of Pediatrics and Emergency Medicine (Osmond, Plint), University of Ottawa, Ottawa, Ont.
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Martin H. Osmond
Department of Pediatrics (Dixon), University of Alberta; Stollery Children’s Hospital (Dixon), Edmonton, Alta.; Clinical Research Unit (Barrowman), Children’s Hospital of Eastern Ontario Research Institute; Children’s Hospital of Eastern Ontario Research Institute (Clarkin, Correll, Osmond, Plint), Ottawa, Ont.; Department of Pediatrics and Emergency Medicine (Osmond, Plint), University of Ottawa, Ottawa, Ont.
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Amy C. Plint
Department of Pediatrics (Dixon), University of Alberta; Stollery Children’s Hospital (Dixon), Edmonton, Alta.; Clinical Research Unit (Barrowman), Children’s Hospital of Eastern Ontario Research Institute; Children’s Hospital of Eastern Ontario Research Institute (Clarkin, Correll, Osmond, Plint), Ottawa, Ont.; Department of Pediatrics and Emergency Medicine (Osmond, Plint), University of Ottawa, Ottawa, Ont.
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    Figure 1:

    Flow of participants through the study. In this cluster-randomized design, eligible children were assigned to receive nurse- or physician-initiated care based on the day of presentation (cluster). Note: RHS = radial-head subluxation.

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    Table 1:

    Characteristics of children included in the analysis

    CharacteristicNurse-initiated treatment
    n = 124
    Physician-initiated treatment
    n = 121
    Age, yr, mean ± SD (range)2.4 ± 1.0 (0.4–6.2)2.2 ± 1.1 (0.3–5.6)
    Female, no. (%)80 (64.5)68 (56.2)
    Time from injury to triage, min,* median (IQR)88 (45–153)103 (64–109)
    Mechanism of injury, no. (%)
     Pull118 (95.2)92 (76.0)
     Fall5 (4.0)19 (15.7)
     Other1 (0.8)10 (8.3)
    • Note: IQR = interquartile range, SD = standard deviation.

    • ↵* Although the exact time of the injury was not available for 16 patients, the time of injury was known to be less than 12 h before presentation. These patients were not included in the reported data for time from injury to triage.

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    Table 2:

    Clinical outcomes among children assigned to nurse- or physician-initiated radial-head subluxation

    OutcomeNo. (%)* of childrenDifference, % (95% CI) or p value
    Nurse-initiated treatment
    n = 124
    Physician-initiated treatment
    n = 121
    Successful reduction by randomized care provider105 (84.7)117 (96.7)12.0% (4.8% to 19.7%)
    Successful reduction by physician16 (12.9)117 (96.7)
    Length of stay in the emergency department, min,† median (range)50 (32–82)105 (63–150)55, < 0.001‡
    Reduction attempted, fracture subsequently diagnosed1 (0.8)0
    Underwent radiography8/124 (6.5)14/121 (11.6)0.2§
    • ↵* Unless otherwise stated

    • ↵† Length of stay data was missing for 2 children.

    • ↵‡ Wilcoxon Rank Sum test.

    • ↵§ Z test.

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Canadian Medical Association Journal: 186 (9)
CMAJ
Vol. 186, Issue 9
10 Jun 2014
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Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial
Andrew Dixon, Chantalle Clarkin, Nick Barrowman, Rhonda Correll, Martin H. Osmond, Amy C. Plint
CMAJ Jun 2014, 186 (9) E317-E323; DOI: 10.1503/cmaj.131101

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Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial
Andrew Dixon, Chantalle Clarkin, Nick Barrowman, Rhonda Correll, Martin H. Osmond, Amy C. Plint
CMAJ Jun 2014, 186 (9) E317-E323; DOI: 10.1503/cmaj.131101
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