Introduction of the low risk ankle rule to a paediatric emergency department
| Autor: | I Okafor, Nandini Kandamany, R McNamara, O. Callender, P. Tormey, Patrick Fitzpatrick |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Risk medicine.medical_specialty Adolescent Health Personnel Radiography Clinical prediction rule Audit Fractures Bone 03 medical and health sciences 0302 clinical medicine Ankle injury Clinical Decision Rules Humans Medicine Ankle Injuries Practice Patterns Physicians' Child General Environmental Science 030222 orthopedics business.industry 030208 emergency & critical care medicine Knowledge medicine.anatomical_structure Child Preschool Physical therapy General Earth and Planetary Sciences Female Ankle Emergency Service Hospital business Paediatric emergency |
| Zdroj: | Injury. 51:633-635 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2020.01.040 |
| Popis: | Introduction Ankle injuries are a common presentation to the paediatric emergency department (PED), accounting for approximately 2% of presentations.1 X-rays are ordered for 85–95% of patients but only 12% of x-rays reveal a fracture. Clinical prediction rules, such as The Low Risk Ankle Rule (LRAR) exist to help clinicians safely reduce the frequency of radiography in these injuries. The LRAR has been shown to reduce imaging by up to 60% without missing any clinically significant fractures. We sought to introduce The LRAR into our department and study its outcomes on our practice. Aims To introduce the LRAR into our department and study its effects on our radiography rate and length of stay (LOS). Methods An audit of x-ray rates in ankle injuries in 2016 was performed to determine our department's baseline rate of radiography and LOS. We then conducted education sessions and created x-ray ordering prompts to encourage clinicians to use the LRAR. We introduced the LRAR, with a pilot period initially, and gathered data prospectively. Results 969 patients presented in with an ankle injury in 2016, 90.7% of these patients had an x-ray. The median LOS was 109 min. 92 patients presented during the LRAR implementation period with an ankle injury. Nine patients had exclusion criteria from using the LRAR and the attending physician did not use the LRAR in four patients. Of the remaining 79 patients, 49 had a LRAR positive exam. Only one of these patients went on to have an x-ray, which was normal. The 30 patients with a LRAR negative exam all had an x-ray. Overall, our x-ray rate during the study period was 40/92 (43.4%), a reduction of 47.3%. The average LOS during the study was 101 min. No clinically significant fractures were missed. Conclusion The LRAR can safely and effectively reduce the rate of radiography in ankle injuries, without missing any clinically significant fractures. |
| Databáze: | OpenAIRE |
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