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Research Article| Volume 53, ISSUE 10, P3269-3275, October 2022

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Intervention rates are low after direct discharge from the Edinburgh trauma triage clinic: Outcomes of 6,688 patients

Published:July 28, 2022DOI:https://doi.org/10.1016/j.injury.2022.07.039
Intervention rates are low after direct discharge from the Edinburgh trauma triage clinic: Outcomes of 6,688 patients
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      Abstract

      Aim

      The Edinburgh Trauma Triage clinic (TTC) is an established form of Virtual Fracture clinic (VFC) that permits the direct discharge of simple, isolated fractures from the Emergency Department (ED). Small, short-term cohort studies of similar systems have been published, but to detect low rates of complications requires a large study sample and longer-term follow-up. This study details the outcomes of all patients with injuries suitable for a direct discharge protocol over a four-year period, reviewed at a minimum of three years after attendance.

      Patients

      All TTC records between February 2014 and December 2017 were collated from a prospective database. Fractures of the radial head, little finger metacarpal, fifth metatarsal, toe phalanges and mallet finger injuries were included. TTC outcome, including any deviations from a well-established direct discharge protocol, were noted. All records were re-assessed at a minimum of 36 months after TTC triage (mean 54 months) to ascertain which injuries attended the trauma clinic after initial discharge. Reasons for attendance, the source of referral and any subsequent surgical procedures were identified.

      Results

      There were 6688 patients with fractures of the radial head (1861), little finger metacarpal (1621), fifth metatarsal (1916), toe phalanges (920) and mallet finger injuries (370). 298 (6%) patients were re-referred after direct discharge and attended trauma clinic at a mean time after injury of 11.9 weeks, of whom 11 (0.2%) underwent a surgical intervention. Serious adverse events, defined as those in which a patient may not have come to harm if early clinical review had been undertaken, occurred in 1 patient (0.01%).

      Conclusion

      Intervention after direct discharge of simple pre-defined injuries of the elbow, hand and foot is low. Within a TTC system, patients with these injuries can be safely discharged without routine follow-up.
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      References

        • Mackenzie S.P.
        • Carter T.H.
        • Jefferies J.G.
        • Wilby J.B.J.
        • Hall P.
        • Duckworth A.D.
        • et al.
        Discharged but not dissatisfied: outcomes and satisfaction of patients discharged from the edinburgh trauma triage clinic.
        Bone Joint J. 2018; 100: 959-965
        View in Article
        • White T.O.
        • Mackenzie S.P.
        • Carter T.H.
        • Jefferies J.G.
        • Prescott O.R.
        • Duckworth A.D.
        • et al.
        The evolution of fracture clinic design: the activity and safety of the Edinburgh Trauma Triage Clinic, with one-year follow-up.
        Bone Joint J. 2017; 99-B: 503-507
        View in Article
        • Vardy J.
        • Jenkins P.J.
        • Clark K.
        • Chekroud M.
        • Begbie K.
        • Anthony I.
        • et al.
        Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance.
        BMJ Open. 2014; 4e005282
        View in Article
        • Bhattacharyya R.
        • Jayaram P.R.
        • Holliday R.
        • Jenkins P.
        • Anthony I.
        • Rymaszewski L.A.
        The virtual fracture clinic: reducing unnecessary review of clavicle fractures.
        Injury. 2017; 48: 720-723
        View in Article
        • Holgate J.
        • Kirmani S.
        • Anand B.
        Virtual fracture clinic delivers British Orthopaedic Association compliance.
        Ann R Coll Surg Engl. 2017; 99: 51-54
        View in Article
        • Little M.
        • Huntley D.
        • Morris J.
        • Jozsa F.
        • Hardman J.
        • Anakwe R.E.
        The virtual fracture clinic improves quality of care for patients with hand and wrist injuries: an assessment of 3709 patients.
        J Hand Surg Eur Vol. 2020; 45: 748-753
        View in Article
        • Iannuzzi N.P.
        • Leopold S.S.
        In brief: the Mason classification of radial head fractures.
        Clin Orthop Relat Res. 2012; 470: 1799-1802
        View in Article
        • Cheung C.N.
        • Lui T.H.
        Proximal fifth metatarsal fractures: anatomy, classification, treatment and complications.
        Arch Trauma Res. 2016; 5: e33298
        View in Article

      9. No authors listed. NHS Royal Free London: virtual fracture clinic. https://www.royalfree.nhs.uk/services/services-a-z/trauma-and-orthopaedics/virtual-fracture-clinic/ (date last accessed 06 February 2022).

        View in Article

      10. No authors listed. NHS University Hospitals of Morecambe Bay: virtual Fracture Clinic. https://www.uhmb.nhs.uk/our-services/services/virtual-fracture-clinic (date last accessed 06 February 2022).

        View in Article

      11. No authors listed. NHS University Hospitals Sussex: NHS Virtual Fracture Clinic. https://www.fracturecare.co.uk/ (date last accessed 06 February 2022).

        View in Article

      12. No authors listed. NHS Liverpool University Hospitals: virtual Fracture Clinic (VFC). https://www.rlbuht.nhs.uk/departments/medical-specialisms/acute-and-emergency-care/trauma-and-orthopaedics/virtual-fracture-clinic-vfc/ (date last accessed 06 February 2022).

        View in Article

      13. No authors listed. NHS University College London Hospitals: virtual Fracture Clinic. https://www.uclh.nhs.uk/our-services/find-service/orthopaedics-and-trauma/virtual-fracture-clinic (date last accessed 06 February 2022).

        View in Article

      14. No authors listed. NHS Maidstone and Tunbridge Wells: virtual Fracture Clinic (VFC). https://www.mtw.nhs.uk/service/trauma-orthopaedics/virtual-fracture-clinic-vfc/ (date last accessed 06 February 2022).

        View in Article

      15. No authors listed. NHS The Leeds Teaching Hospitals: virtual Fracture Clinic for Adults. https://www.leedsth.nhs.uk/a-z-of-services/virtual-fracture-clinic-for-adults/ (date last accessed 06 February 2022).

        View in Article

      16. No authors listed. NHS King's College Hospital: virtual fracture clinic for patients with acute bone injury not requiring immediate on-call review. https://www.nhsx.nhs.uk/key-tools-and-info/digital-playbooks/musculoskeletal-digital-playbook/virtual-fracture-clinic-for-patients-with-acute-bone-injury-not-requiring-immediate-on-call-review/ (date last accessed 06 February 2022).

        View in Article

      17. No authors listed. NHS Mid Cheshire Hospitals: virtual Fracture Clinic. https://www.mcht.nhs.uk/in

        View in Article

      18. No authors listed. NHS Portsmouth Hospitals: virtual Fracture Clinic. https://www.porthosp.nhs.uk/departments-and-services/virtual-fracture-clinic/96350 (date last accessed 06 February 2022).

        View in Article

      19. No authors listed. NHS Greater Glasgow and clyde: fracture clinics/trauma pathway. https://www.nhsggc.org.uk/your-health/health-services/orthopaedics/fracture-clinic-information/ (date last accessed 06 February 2022).

        View in Article

      20. No authors listed. NHS Whittington Health: virtual Fracture Clinic. https://www.whittington.nhs.uk/default.asp?c=41973 (date last accessed 06 February 2022).

        View in Article

      21. No authors listed. NHS Bedfordshire Hospitals: virtual Fracture Clinic (VFC). https://www.bedfordshirehospitals.nhs.uk/our-services/orthopaedics-and-trauma/virtual-fracture-clinic-vfc/ (date last accessed 06 February 2022).

        View in Article

      22. No authors listed. NHS Northampton General Hospital: virtual Fracture Clinic (VFC). https://www.northamptongeneral.nhs.uk/Services/Our-Clinical-Services-and-Departments/Trauma-and-Orthopaedics/Virtual-Fracture-Clinic.aspx (date last accessed 06 February 2022).

        View in Article
        • Rhind J.H.
        • Ramhamadany E.
        • Collins R.
        • Govilkar S.
        • Dass D.
        • Hay S.
        An analysis of virtual fracture clinics in orthopaedic trauma in the UK during the coronavirus crisis.
        EFORT Open Rev. 2020; 5: 442-448
        View in Article
        • Ng Z.H.
        • Downie S.
        • Makaram N.S.
        • Kolhe S.N.
        • Mackenzie S.P.
        • Clement N.D.
        • et al.
        A multicentre national study of the effectiveness of virtual fracture clinic management of orthopaedic trauma during the COVID-19 pandemic (MAVCOV): a cross-sectional study protocol.
        Bone Jt Open. 2021; 2: 211-215
        View in Article
        • Sharma A.
        • Butt M.I.
        • Ajayi B.
        • Perkins S.
        • Umarji S.
        • Hing C.
        • et al.
        A hybrid virtual fracture clinic is safe and efficacious in the COVID-19 Era: stay at Home and Save Lives.
        Cureus. 2021; 13: e14849
        View in Article
        • Davey M.S.
        • Coveney E.
        • Rowan F.
        • Cassidy J.T.
        • Cleary M.S.
        Virtual fracture clinics in orthopaedic surgery - a systematic review of current evidence.
        Injury. 2020; 51: 2757-2762
        View in Article
        • Khan S.A.
        • Asokan A.
        • Handford C.
        • Logan P.
        • Moores T.
        How useful are virtual fracture clinics?: a systematic review.
        Bone Jt Open. 2020; 1: 683-690
        View in Article
        • Murphy E.P.
        • Fenelon C.
        • Murphy R.P.
        • O'Sullivan M.D.
        • Pomeroy E.
        • Sheehan E.
        • et al.
        Are virtual fracture clinics during the covid-19 pandemic a potential alternative for delivering fracture care? A systematic review.
        Clin Orthop Relat Res. 2020; 478: 2610-2621
        View in Article
        • Brogan K.
        • Bellringer S.
        • Akehurst H.
        • Gee C.
        • Ibrahim N.
        • Cassidy L.
        • et al.
        Virtual fracture clinic management of fifth metatarsal, including Jones', fractures is safe and cost-effective.
        Injury. 2017; 48: 966-970
        View in Article
        • Brooksbank K.
        • Jenkins P.J.
        • Anthony I.C.
        • Gilmour A.
        • Nugent M.P.
        • Rymaszewski L.A.
        Functional outcome and satisfaction with a "self-care" protocol for the management of mallet finger injuries: a case-series.
        J Trauma Manag Outcomes. 2014; 8: 21
        View in Article
        • Ferguson K.B.
        • McGlynn J.
        • Jenkins P.
        • Madeley N.J.
        • Kumar C.S.
        • Rymaszewski L
        Fifth metatarsal fractures - Is routine follow-up necessary?.
        Injury. 2015; 46: 1664-1668
        View in Article
        • Gamble D.
        • Jenkins P.J.
        • Edge M.J.
        • Gilmour A.
        • Anthony I.C.
        • Nugent
        • et al.
        Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures.
        Hand (N Y). 2015; 10: 607-612
        View in Article
        • Jayaram P.R.
        • Bhattacharyya R.
        • Jenkins P.J.
        • Anthony I.
        • Rymaszewski L.A
        A new "virtual" patient pathway for the management of radial head and neck fractures.
        J Shoulder Elbow Surg. 2014; 23: 297-301
        View in Article
        • O' Reilly M.
        • Breathnach O.
        • Conlon B.
        • Kiernan C.
        • Sheehan E.
        Trauma assessment clinic: virtually a safe and smarter way of managing trauma care in Ireland.
        Injury. 2019 Apr; 50: 898-902
        View in Article
        • Breathnach O.
        • O'Reilly M.
        • Morrissey K.
        • Conlon B.
        • Sheehan E.
        Electronic referrals for virtual fracture clinic service using the National Integrated Medical Imaging System (NIMIS).
        Ir J Med Sci. 2019 May; 188: 371-377
        View in Article

      Article info

      Publication history

      Published online: July 28, 2022
      Accepted: July 25, 2022

      Identification

      DOI: https://doi.org/10.1016/j.injury.2022.07.039

      Copyright

      © 2022 Elsevier Ltd. All rights reserved.

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