Paediatric distal radial fracture manipulation: multicentre analysis of process times

Emergency Medicine Journal 26 (1), 41-2 (Jan 2009) Mitchell L, Archer E, Middleton S, Maclean A, Jones L, Benger J, Lloyd G;

BACKGROUND: Children with simple radial fractures requiring manipulation are conventionally admitted for manipulation under general anaesthesia. On the assumption that children (and their parents) wish to spend as little time in hospital as possible, a study was undertaken to explore the experience of children with distal radial fractures admitted for general anaesthesia. METHODS: A retrospective analysis was performed of the time taken from arrival at the emergency department (ED) to general anaesthesia and the time taken from arrival at the ED to hospital discharge in three centres in south-west England: the Bristol Children's Hospital, Derriford (Plymouth) Hospital and the Royal Devon&Exeter Hospital. RESULTS: The median wait for general anaesthesia was>8 h and the median wait from ED admission to discharge was>21 h. This compares with a typical arrival to discharge time for paediatric procedural sedation of 4-5 h in the ED of the Royal Devon&Exeter Hospital. CONCLUSIONS: Given the assumption that children (and their parents) wish to spend as little time in hospital as possible, there appears to be a role for procedural sedation in the ED for this group of children, with a significantly reduced turnaround time anticipated.