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
Netherlands
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.
Received:
September 21, 2023; Published: October 10, 2023
Abstract
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
References
- Kiss K., et al. “Bicycle injuries in children: an analysis based on demographic density”. Accident Analysis and Prevention 42 (2010): 1566-1569.
- Kramer WL and Haaring GJ. “[Bicycle spoke-related injuries in children: emphasise prevention]”. Nederlands Tijdschrift voor Geneeskunde 155 (2011): A3736.
- Mak CY., et al. “Bicycle and motorcycle wheel spoke injury in children”. Journal of Orthopaedic Surgery (Hong Kong) 23 (2015): 56-58.
- NL V Letsel Informatie Systeem 2014-2018.
- Sturms LM., et al. “[Bicycle spoke injuries in children: accident details and consequences]”. Nederlands Tijdschrift voor Geneeskunde 146 (2002): 1691-1696.
- Chu G., et al. “Emergency department management and follow-up of children with bicycle spoke injuries”. Journal of Emergency Medicine 47 (2014): 259-267.
- Geerdink TH., et al. “[Direct discharge from the ED for patients with simple stable injuries: a Dutch pilot study]”. Nederlands Tijdschrift voor Geneeskunde (2020): 164.
- Khan SA., et al. “How useful are virtual fracture clinics?: a systematic review”. Bone and Joint Open 1 (2020): 683-690.
- Mackenzie SP., et al. “Discharged but not dissatisfied: outcomes and satisfaction of patients discharged from the Edinburgh Trauma Triage Clinic”. The Bone and Joint Journal 100-B (2018): 959-965.
- Rhind JH., et al. “An analysis of virtual fracture clinics in orthopaedic trauma in the UK during the coronavirus crisis”. EFORT Open Reviews 5 (2020): 442-448.
- Geerdink TH., et al. “Direct discharge from the emergency department of simple stable injuries: a propensity score-adjusted non-inferiority trial”. Trauma Surgery and Acute Care Open 6 (2021): e000709.
- Hasaart F. “Incentives in the diagnosis treatment combination payment system for specialist medical care: a study about behavioral responses of medical specialists and hospitals in the Netherlands”, Maastricht University (2011).
- Hakkaart-van Roijen L vdLN., et al. “Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg, Bijlage 1: Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg. (2015) Diemen: Zorginstituut Nederland (2011).
- OHRA Wat kost een behandeling eigenlijk?, OHRA (2021).
- Corp I IBM SPSS Statistics for Windows, version 27.0. In: IBM editor (2020).
- Cavka B., et al. “Retrospective cohort study evaluating the efficacy and safety of an orthopaedic consultant-led virtual fracture clinic in an Australian level 1 trauma centre”. ANZ Journal of Surgery 91 (2021): 1441-1446.
- Kennedy J., et al. “One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures”. Journal of Children's Orthopaedics 15 (2021): 186-193.
- Jenkins PJ., et al. “Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care”. Bone and Joint Research 5 (2016): 33-36.
- McKirdy A and Imbuldeniya AM. “The clinical and cost effectiveness of a virtual fracture clinic service: An interrupted time series analysis and before-and-after comparison”. Bone and Joint Research 6 (2017): 259-269.
- Geerdink TH., et al. “Cost-effectiveness of direct discharge from the emergency department of patients with simple stable injuries in the Netherlands”. Trauma Surgery and Acute Care Open 6 (2021): e000763.
- Marson BA., et al. “Quality of patient-reported outcomes used for quality of life, physical function, and functional capacity in trials of childhood fractures”. The Bone and Joint Journal 102-B (2020): 1599-1607.
Citation
Copyright