The Effects of a Direct Discharge Protocol in Children with a Bicycle Spoke Injury.
G (Gijs) JA Willinge1*, SB van Gelder, MD1, JF Spierings2, TH Geerdink1, JC Goslings1, RN van Veen1, MC Kokke2 and BA Twigt1
1OLVG Hospital, Amsterdam, Department of Trauma surgery, Amsterdam, The
1St. Antonius Hospital Utrecht, Department of Trauma Surgery, The Netherlands
*Corresponding Author: G (Gijs) JA Willinge, OLVG Hospital, Amsterdam,
Department of Trauma surgery, Amsterdam, The Netherlands.
September 21, 2023; Published: October 10, 2023
Background: Direct discharge (DD) from the emergency department (ED) may provide an efficient treatment option for children with a bicycle spoke injury. Although DD has been widely implemented in the Netherlands, injury specific results are lacking. This study aimed to assess the effects of DD on the treatment of children (aged <12 years) with a bicycle spoke injury compared to traditional treatment.
Patients and Methods: In this retrospective cohort study, patients aged <12 years with a bicycle spoke injury treated between January 2018 and November 2020 were included. Outcomes included secondary healthcare utilization, protocol compliance, ED reattendances and hospital treatment costs. Patient-reported outcomes and primary healthcare utilization were evaluated via an online questionnaire.
Results: The pre-DD group consisted of 102 patients and the DD group of 121. DD resulted in fewer follow-up appointments (median:1, range:3) compared to pre-DD treatment (median:0, range:4). Protocol compliance by ED caregivers was 86% in pre-DD patients vs. 88% in DD patients. ED reattendances were low and comparable in both groups. DD consequently resulted in a reduction of calculated hospital treatment costs. No persistent functional limitations or shift to primary healthcare were reported.
Conclusions: In this study, treatment of children (aged <12) with a bicycle spoke injury through DD reduced secondary healthcare utilization compared to traditional treatment, with a high protocol compliance rate. DD did not increase ED reattendances or negatively affect treatment outcomes.
Keywords: Bycicle Spoke Injury; Pediatric; Trauma; Virtual Fracture Clinic; Direct Discharge; Healthcare Utilization
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