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

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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.

Table 1:

Characteristics of children included in the analysis

Characteristic	Nurse-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. (%)
Pull	118 (95.2)	92 (76.0)
Fall	5 (4.0)	19 (15.7)
Other	1 (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.

Table 2:

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

Outcome	No. (%)^* of children		Difference, % (95% CI) or p value
Outcome	Nurse-initiated treatment n = 124	Physician-initiated treatment n = 121	Difference, % (95% CI) or p value
Successful reduction by randomized care provider	105 (84.7)	117 (96.7)	12.0% (4.8% to 19.7%)
Successful reduction by physician	16 (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 diagnosed	1 (0.8)	0
Underwent radiography	8/124 (6.5)	14/121 (11.6)	0.2^§