Dixon Andrew, Clarkin Chantalle, Barrowman Nick, Correll Rhonda, Osmond Martin H, Plint Amy C
Department of Pediatrics (Dixon), University of Alberta; Stollery Children's Hospital (Dixon), Edmonton, Alta.; Clinical Research Unit (Barrowman), Children's Hospital of Eastern Ontario Research Institute; Children's Hospital of Eastern Ontario Research Institute (Clarkin, Correll, Osmond, Plint), Ottawa, Ont.; Department of Pediatrics and Emergency Medicine (Osmond, Plint), University of Ottawa, Ottawa, Ont.
CMAJ. 2014 Jun 10;186(9):E317-23. doi: 10.1503/cmaj.131101. Epub 2014 Mar 24.
Radial-head subluxation is an easily identified and treated injury. We investigated whether triage nurses in the emergency department can safely reduce radial-head subluxation at rates that are not substantially lower than those of emergency department physicians.
We performed an open, noninferiority, cluster-randomized control trial. Children aged 6 years and younger who presented to the emergency department with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours were assigned to either nurse-initiated or physician-initiated treatment, depending on the day. The primary outcome was the proportion of children who had a successful reduction (return to normal arm usage). We used a noninferiority margin of 10%.
In total, 268 children were eligible for inclusion and 245 were included in the final analysis. Of the children assigned to receive physician-initiated care, 96.7% (117/121) had a successful reduction performed by a physician. Of the children assigned to receive nurse-treatment care, 84.7% (105/124) had a successful reduction performed by a nurse. The difference in the proportion of successful radial head subluxations between the groups was 12.0% (95% confidence interval [CI] 4.8% to 19.7%). Noninferiority of nurse-initiated radial head subluxation was not shown.
In this trial, the rate of successful radial-head subluxation performed by nurses was inferior to the physician success rate. Although the success rate in the nurse-initiated care group did not meet the non-inferiority margin, nurses were able to reduce radial head subluxation for almost 85% of children who presented with probable radial-head subluxation.
Clinical Trials.gov, no. NCT00993954.
桡骨头半脱位是一种易于识别和治疗的损伤。我们调查了急诊科的分诊护士是否能够以不显著低于急诊科医生的成功率安全地复位桡骨头半脱位。
我们进行了一项开放、非劣效性、整群随机对照试验。6岁及以下因与桡骨头半脱位相符的症状就诊于急诊科且在过去12小时内有已知损伤的儿童，根据日期被分配接受护士启动或医生启动的治疗。主要结局是复位成功（恢复正常手臂使用）的儿童比例。我们使用了10%的非劣效性界值。
共有268名儿童符合纳入标准，245名被纳入最终分析。在被分配接受医生启动治疗的儿童中，96.7%（117/121）由医生成功复位。在被分配接受护士治疗的儿童中，84.7%（105/124）由护士成功复位。两组之间成功复位桡骨头半脱位的比例差异为12.0%（95%置信区间[CI]4.8%至19.7%）。未显示护士启动的桡骨头半脱位复位具有非劣效性。
在本试验中，护士进行桡骨头半脱位成功复位的比例低于医生的成功率。尽管护士启动治疗组的成功率未达到非劣效性界值，但护士能够为几乎85%表现为可能桡骨头半脱位的儿童复位桡骨头半脱位。
ClinicalTrials.gov，编号NCT00993954。
