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Radial head subluxation: How long do children wait in the emergency department before reduction?

Published online by Cambridge University Press:  31 July 2018

Philippe Toupin ,
Martin H. Osmond ,
Rhonda Correll  and
Amy Plint
Philippe Toupin
Affiliation:
School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont
Martin H. Osmond*
Affiliation:
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ont
Rhonda Correll
Affiliation:
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont
Amy Plint
Affiliation:
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ont
*
Division of Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1; osmond@cheo.on.ca

Abstract

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Objective:

To describe the current emergency department (ED) wait times and treatment characteristics of children with radial head subluxation (RHS).

Methods:

We performed a 2-year retrospective medical record review (April 1, 2004, to March 31, 2006) of all children who presented to our tertiary care pediatric ED with a discharge diagnosis of RHS, pulled elbow, dislocated elbow or nursemaid's elbow.

Results:

We identified 501 cases of RHS in 427 children over a 2-year period. The mean age was 2.4 years (range 22 d–9.7 yr) and the injury was caused by a pull in 314 (62.8%) cases, a fall in 91 (18.2%) cases and a twist in 20 (4.0%) of the cases. The median time from triage to physician assessment was 1.3 hours, with 112 (23.5%) patients waiting > 2 hours and 33 (6.9%) waiting > 3 hours. The median time from triage to ED discharge was 1.7 hours, with 193 (41.2%) staying > 2 hours, 85 (18.1%) staying > 3 hours and 30 (6.4%) staying > 4 hours. Overall, 490 (99.2%) of these injuries were reduced in the ED: 98 (19.8%) were reduced prior to physician assessment and 309 (89.6%) were reduced on the first attempt. The technique used was pronation in 138 (52.7%), supination in 100 (38.2%), and pronation and supination in 24 (9.2%) cases.

Conclusion:

This large cohort indicates that children with RHS often have long ED waits before reduction and discharge. The majority of children with RHS are treated successfully with 1 reduction attempt. The data from this study will be used in planning a prospective study to shorten ED visits for patients with RHS.

Keywords

emergency departmentchildrenradial head subluxationpulled elbownursemaid's elbowdislocated elbowwait time
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 5 , September 2007 , pp. 333 - 338
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

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