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Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective

PURPOSE: Closed reduction under conscious sedation in the emergency department (ED) has been demonstrated to provide cost-effective, timely care. There has been little research into the efficacy of conscious sedation and reduction from an orthopaedic trauma perspective. This study describes the epid...

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Autores principales: Yang, B. W., Waters, P. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598038/
https://www.ncbi.nlm.nih.gov/pubmed/31312274
http://dx.doi.org/10.1302/1863-2548.13.190013
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author Yang, B. W.
Waters, P. M.
author_facet Yang, B. W.
Waters, P. M.
author_sort Yang, B. W.
collection PubMed
description PURPOSE: Closed reduction under conscious sedation in the emergency department (ED) has been demonstrated to provide cost-effective, timely care. There has been little research into the efficacy of conscious sedation and reduction from an orthopaedic trauma perspective. This study describes the epidemiology and outcomes associated with fracture conscious sedation and reduction in our level I paediatric ED. METHODS: All fracture patients presenting overnight to our level I trauma centre ED between 01 June 2016 and 30 June 2017 were identified. Patient records were reviewed to determine diagnoses, treatments and outcomes. The rate of repeat intervention after successful conscious sedation and reduction and rate of changes in management in which the orthopaedic resident’s overnight management plan to provide procedural sedation was altered to surgical intervention after morning case review rounds was calculated. RESULTS: Conscious sedation and reduction was performed on a total of 386 patients covering ten fracture types during the course of our study, with distal radius fractures (n = 167, 43.3%) comprising the majority of cases. A total of 53 cases (13.7%, 53/386) lost alignment and required repeat intervention, consisting of 33 cases (8.5%, 33/386) that required repeat surgery and 5.2% (20/386) that required cast wedging. In all, 12 patients (3.1%, 12/386) initially reduced under conscious sedation required a change in management and surgical intervention. There were five cases of growth arrest and two cases of malunion. CONCLUSIONS: Conscious sedation and reduction provides an alternative to general anaesthesia for many paediatric trauma injuries without compromising patient outcomes LEVEL OF EVIDENCE: IV
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spelling pubmed-65980382019-07-16 Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective Yang, B. W. Waters, P. M. J Child Orthop Original Clinical Article PURPOSE: Closed reduction under conscious sedation in the emergency department (ED) has been demonstrated to provide cost-effective, timely care. There has been little research into the efficacy of conscious sedation and reduction from an orthopaedic trauma perspective. This study describes the epidemiology and outcomes associated with fracture conscious sedation and reduction in our level I paediatric ED. METHODS: All fracture patients presenting overnight to our level I trauma centre ED between 01 June 2016 and 30 June 2017 were identified. Patient records were reviewed to determine diagnoses, treatments and outcomes. The rate of repeat intervention after successful conscious sedation and reduction and rate of changes in management in which the orthopaedic resident’s overnight management plan to provide procedural sedation was altered to surgical intervention after morning case review rounds was calculated. RESULTS: Conscious sedation and reduction was performed on a total of 386 patients covering ten fracture types during the course of our study, with distal radius fractures (n = 167, 43.3%) comprising the majority of cases. A total of 53 cases (13.7%, 53/386) lost alignment and required repeat intervention, consisting of 33 cases (8.5%, 33/386) that required repeat surgery and 5.2% (20/386) that required cast wedging. In all, 12 patients (3.1%, 12/386) initially reduced under conscious sedation required a change in management and surgical intervention. There were five cases of growth arrest and two cases of malunion. CONCLUSIONS: Conscious sedation and reduction provides an alternative to general anaesthesia for many paediatric trauma injuries without compromising patient outcomes LEVEL OF EVIDENCE: IV The British Editorial Society of Bone & Joint Surgery 2019-06-01 /pmc/articles/PMC6598038/ /pubmed/31312274 http://dx.doi.org/10.1302/1863-2548.13.190013 Text en Copyright © 2019, The author(s) http://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Original Clinical Article
Yang, B. W.
Waters, P. M.
Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective
title Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective
title_full Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective
title_fullStr Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective
title_full_unstemmed Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective
title_short Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective
title_sort conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598038/
https://www.ncbi.nlm.nih.gov/pubmed/31312274
http://dx.doi.org/10.1302/1863-2548.13.190013
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