1569 Paediatric Upper Limb Fracture Manipulation in A Children’s Emergency Department: Practice Changes During The COVID-19 Pandemic

Autor:	T Crompton, M Derias, N Morrissey, J Porter, G Alexander-Harvey, Kyle James, J Amen, S Maripuri
Rok vydání:	2021
Předmět:	medicine.medical_specialty 2019-20 coronavirus outbreak Coronavirus disease 2019 (COVID-19) business.industry Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Emergency medicine Pandemic Upper Limb Fracture medicine Surgery Emergency department business
Zdroj:	British Journal of Surgery. 108
ISSN:	1365-2168 0007-1323
DOI:	10.1093/bjs/znab259.510
Popis:	Background Trauma theatre time is valuable and previous studies reported cost of £24.77/minute. BSUH Children’s emergency department (CED) guidelines were implemented in December 2016, allowing reduction of forearm and distal radius (DR) fractures in CED using 70% nitrous (N2O) sedation. Due to COVID-19 pandemic and the risks associated with aerosol generating procedures as well as staffing levels, CED shifted to using 50%N2O with or without intranasal fentanyl. Method Relevant fractures presenting to CED from Feb-Dec 2020 were identified and compared to previous years. Demographics, treatment modality, timings, and outcomes were reviewed for 275 patients. Results In 2017-2018, 56% were manipulated in CED under 70%N2O (compared to only 3% in 2016). The main barrier identified was shortage of doctors trained in sedation to supervise use of 70%N20. In 2020, 101 patients were suitable for manipulation in CED. 64 had DR fractures, 37 midshaft fractures, 65 were male. Mean age: 10 years. 92 patients (91%) were manipulated in CED/fracture clinic. One was under 70%N2O; the rest used 50%N2O with or without intranasal fentanyl. 8 (9%) had manipulation under GA. Of those manipulated in CED, 3 were re-manipulated in clinic for cast problems. A typical MUA takes 30minutes indicating a saving of £743 per case; therefore, £68,356 over the study period. Conclusions Paediatric upper limb fracture manipulation in CED under N2O is effective and provides significant cost savings. Due to changes related to COVID-19 pandemic, considerably more patients in 2020 were safely treated in CED/clinic. Using 50%N2O improves uptake due to lower staffing requirements.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::45eb0d5b68406469a8a79d9b39bb5fa7 https://doi.org/10.1093/bjs/znab259.510 Zobrazit plný text záznamu