Radial head subluxation: how long do children wait in the emergency department before reduction?

OBJECTIVE

To describe the current emergency department (ED) wait times and treatment characteristics of children with radial head subluxation (RHS).

METHODS

We performed a 2-year retrospective medical record review (April 1, 2004, to March 31, 2006) of all children who presented to our tertiary care pediatric ED with a discharge diagnosis of RHS, pulled elbow, dislocated elbow or nursemaid's elbow.

RESULTS

We identified 501 cases of RHS in 427 children over a 2-year period. The mean age was 2.4 years (range 22 d-9.7 yr) and the injury was caused by a pull in 314 (62.8%) cases, a fall in 91 (18.2%) cases and a twist in 20 (4.0%) of the cases. The median time from triage to physician assessment was 1.3 hours, with 112 (23.5%) patients waiting > 2 hours and 33 (6.9%) waiting > 3 hours. The median time from triage to ED discharge was 1.7 hours, with 193 (41.2%) staying > 2 hours, 85 (18.1%) staying > 3 hours and 30 (6.4%) staying > 4 hours. Overall, 490 (99.2%) of these injuries were reduced in the ED: 98 (19.8%) were reduced prior to physician assessment and 309 (89.6%) were reduced on the first attempt. The technique used was pronation in 138 (52.7%), supination in 100 (38.2%), and pronation and supination in 24 (9.2%) cases.

CONCLUSION

This large cohort indicates that children with RHS often have long ED waits before reduction and discharge. The majority of children with RHS are treated successfully with 1 reduction attempt. The data from this study will be used in planning a prospective study to shorten ED visits for patients with RHS.