93 Managing paediatric torus fractures at the Royal London Hospital: A Clinical Audit and Cost Analysis
C Papaioannou, D Manoukian- Surgery
Abstract
Aim
Torus fractures are extremely common, accounting for up to 25% of all paediatric-related visits to the emergency department (ED). This audit aims to assess the adherence of the Royal London Hospital (RLH) to the NG38 NICE guidelines. These guidelines state that patients should not be given a rigid cast and should be discharged, advising carers a follow-up is not required.
Method
We analysed and retrospectively collected data from a cohort of paediatric patients with torus fractures who presented at the RLH between September 2021 and December 2021. In total 59 patients were included in the audit. Recommendations were later presented at the paediatric orthopaedic meeting of the RLH.
Results
From the cohort, 22% of patients were given inappropriate treatment including rigid casts with or without manipulation, with an average time in cast of 3.8 weeks. 18.6% of all the patients were followed-up in clinic, including 54.5% of the patients who received a rigid cast during discharge from the ED (the rest returned only for cast removal). 63.6% of the patients who returned for follow-up had a repeat X-Ray performed.
Conclusions
Overall, 18 out of 59 (30.5%) cases were not managed according to NICE guidelines (received inappropriate treatment, had a clinic follow-up with a clinician or was referred for >1 X-Ray). This incurred an inappropriate cumulative cost of almost 2000£ only during a 4-month period from one hospital. This audit aims to educate ED staff and update local protocols. A re-audit is going to follow to assess the impact of these recommendations.