Enhancing Patient Management and Financial Efficiency: Adherence to National Institute for Health and Care Excellence (NICE) Guidelines for Pediatric Distal Radius Buckle Fractures.

INTRODUCTION

Pediatric distal radius buckle fractures are commonly encountered in the emergency department (ED) and are considered non-complex and stable injuries. The National Institute for Health and Care Excellence (NICE) guidelines recommend managing these fractures with a soft cast and discharging patients directly from the ED. However, prevailing practices often involve rigid casts and follow-up clinic visits, leading to unnecessary congestion, prolonged waiting times, excessive radiographic examinations, and frequent cast changes, resulting in additional financial burdens on hospitals.

METHODS AND MATERIALS

We conducted an initial audit over a 6-month period at Hull University and Teaching Hospitals, reviewing 184 pediatric distal radius fractures, of which 84 were buckle fractures in children under 12 years old. Data on demographics, subsequent clinic visits, treating doctor's grade, additional radiographs, initial and final treatment approaches, and cast change frequency were collected. After the initial audit, NICE guideline compliance was promoted through the education of parents and healthcare providers. A second audit was performed on patients within the following 6-month period.

RESULTS

This study assessed the management of pediatric distal radius buckle fractures in a cohort of 84 patients. 39/84 (46.4%) of patients sought medical attention within one week of sustaining the injury, with 33/84 individuals being discharged during their first visit, either by consultants or registrars. Most patients (69/84) required only a single X-ray examination in the ED, while some needed two or three X-rays during their evaluation. However, after implementing NICE guidelines, in the second audit cycle, 62 out of 64 were discharged directly from the ED, with 42 receiving focal rigidity casts (FRCs) removed at home and 10 discharged with simple crepe bandages.  Conclusions: This closed-loop audit effectively showcased that adherence to NICE guidelines yielded better patient management by avoiding unnecessary visits, radiographs, and platers. The adoption of the guidelines leads to the conservation of time and resources.