Nurse Reduction of Pulled Elbow

NCT00993954 | Completed Results DMC

• 1 other identifier: 08/29x
• Study Type: interventional
• Target: 245
• Locations: 1 country
• Sites: 1

Brief Summary

Radial head subluxation, also known as pulled elbow or nursemaid's elbow, is one of the most common upper extremity injuries in young children and a common reason for an emergency department visit.1 The injury typically occurs when a forceful longitudinal traction is applied to an extended and pronated forearm.2 Children with radial head subluxation are usually easily recognized by their clinical presentation and rapidly treated by a simple reduction technique involving either hyperpronation or supination and flexion of the injured arm.3-7 Despite the relative ease of diagnosis and treatment, children with radial head subluxation often wait several hours in a pediatric emergency department for a reduction that takes only a few minutes.8 Such visits have direct health care costs and involve time and stress for the child and their family. While many factors are associated with parental and patient satisfaction in the emergency department, it appears that that early treatment or intervention and shorter waiting times correlate with patient and parent satisfaction.9,10 As well, patient satisfaction appears to be the same or better when emergency department care for minor injuries is provided by nurse practitioners compared to physicians.11-13 Increasingly nurse initiated treatments and the use of medical directives and clinical pathways are becoming a focus in providing health care.14-17 While radial head subluxation treatment is an appropriate area to consider management by emergency department nurses, no studies have examined their role in the management of this common injury. Our study's objective was to examine whether triage nurses, trained in the use of a medical directive that taught recognition and treatment of radial head subluxation, could successfully reduce radial head subluxation at a rate similar to physicians. Given the practical constraints at the time of emergency department triage, this study was designed as a cluster randomized trial where the unit of randomization was a day and the patients on any given day were assigned to the nurse or physician arm for the entire day.

Conditions

Radial Head Subluxation

Keywords

Nurse Treatment; Pulled Elbow

Outcome Measures

Primary Outcomes (1)

• Proportion of Patients With Successful Reduction of Radial Head Subluxation by Nurse, Compared With Physician Controls

  10-15 minutes post reduction attempt

Secondary Outcomes (3)

• Time to Discharge From ED (Minutes)

  End of enrollment

• Proportion of Patients With Presentation Compatible With RHS, Have Reduction Attempted, Who Are Subsequently Diagnosed With Fracture.

  Every 3 months during enrollment

• Proportion of Patients With RHS Not Identified by Nurse Pathway.

  End of enrollment

Study Arms (2)

Nurse Reduction

EXPERIMENTAL

Patients randomized to reduction by nurse.

Procedure: Reduction of Radial Head Subluxation

Physician Reduction

ACTIVE COMPARATOR

Patients randomized to treatment by Emergency Department Physician in traditional ED manner

Procedure: Reduction of Radial Head Subluxation

Interventions

Reduction of Radial Head Subluxation PROCEDURE

Nurse group will use hyperpronation with extension for first attempt and supination and flexion for second attempt. Physician controls will use either method at their discretion

Nurse Reduction; Physician Reduction

Eligibility Criteria

• Age: Up to 6 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Age up to 6 years
• Physical exam consistent with RHS which includes not using the affected limb, holding the elbow in extension or slight flexion, forearm in pronation, and patient is distressed only on elbow movement
• Injury within preceding 12 hours

You may not qualify if:

• Deformity of clavicle or arm
• Swelling of elbow or wrist
• Significant tenderness on palpation of arm
• Metabolic bone disease (i.e. osteogenesis imperfecta)
• Neuromuscular disorder that excludes adequate assessment (i.e. severe cerebral palsy)

Sponsors & Collaborators

• Children's Hospital of Eastern Ontario: lead
• Ontario Ministry of Health and Long Term Care: collaborator

Study Sites (1)

Childrens Hospital of Eastern Ontario

Ottawa, Ontario, K1H 8L1, Canada

Location

Related Publications (39)

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  PMID: 24664649 DERIVED

Results Point of Contact

• Title: Dr Andrew Dixon
• Organization: University of Alberta

andrew.dixon@albertahealthservices.ca

780-492-3553

Study Officials

• Andrew C Dixon, MD

  University of Alberta

  PRINCIPAL INVESTIGATOR

• Amy Plint, MD

  University of Ottawa

  STUDY DIRECTOR

• Martin Osmond, MD

  University of Ottawa

  STUDY DIRECTOR

• Nick Barrowman, PhD

  University of Ottawa

  STUDY DIRECTOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: October 8, 2009
• First Posted: October 14, 2009
• Study Start: October 1, 2009
• Primary Completion: October 1, 2010
• Study Completion: October 1, 2010
• Last Updated: December 30, 2014
• Results First Posted: December 30, 2014

Record last verified: 2014-12

Locations

CA (1)