RT Journal Article
SR Electronic
T1 Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP cmaj.131101
DO 10.1503/cmaj.131101
A1 Andrew Dixon
A1 Chantalle Clarkin
A1 Nick Barrowman
A1 Rhonda Correll
A1 Martin H. Osmond
A1 Amy C. Plint
YR 2014
UL http://www.cmaj.ca/content/early/2014/03/24/cmaj.131101.abstract
AB Background: Radial-head subluxation is an easily identified and treated injury. We investigated whether triage nurses in the emergency department can safely reduce radial-head subluxation at rates that are not substantially lower than those of emergency department physicians. Methods: We performed an open, noninferiority, cluster-randomized control trial. Children aged 6 years and younger who presented to the emergency department with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours were assigned to either nurse-initiated or physician-initiated treatment, depending on the day. The primary outcome was the proportion of children who had a successful reduction (return to normal arm usage). We used a noninferiority margin of 10%. Results: In total, 268 children were eligible for inclusion and 245 were included in the final analysis. Of the children assigned to receive physician-initiated care, 96.7% (117/121) had a successful reduction performed by a physician. Of the children assigned to receive nurse-treatment care, 84.7% (105/124) had a successful reduction performed by a nurse. The difference in the proportion of successful radial head subluxations between the groups was 12.0% (95% confidence interval [CI] 4.8% to 19.7%). Noninferiority of nurse-initiated radial head subluxation was not shown. Interpretation: In this trial, the rate of successful radial-head subluxation performed by nurses was inferior to the physician success rate. Although the success rate in the nurseinitiated care group did not meet the noninferiority margin, nurses were able to reduce radial head subluxation for almost 85% of children who presented with probable radialhead subluxation. Trial registration: Clinical Trials.gov, no. NCT00993954.