Peer-review started: November 4, 2017
First decision: December 27, 2017
Revised: January 4, 2018
Accepted: February 4, 2018
Article in press: February 5, 2018
Published online: March 18, 2018
Processing time: 132 Days and 12.4 Hours
Children forearm fractures account for up to 40% of fractures that present to the emergency department (ED), majority which could be managed there.
This study improved the quality of care given to children with deformed forearm fractures in the ED.
The main aim of this quality improvement project was to determine if ketamine sedation is a safe and cost-effective way of treating deformed paediatric forearm fractures in the ED.
Over a set 4 mo period we prospectively evaluated a new ketamine protocol for paediatric ED procedural sedation. All eligible children with significantly displaced or unstable fractures of the radius and ulna that presented during daylight weekday hours that needed closed reduction and moulded casting were included.
A total of 10 forearm fractures with a mean 45° angulation deformity were definitively treated in the ED with ketamine procedural sedation. The cost saving was £1470 for each child compared if the patient was taken to theatre. Overall mean parental satisfaction was 9.6 out of 10.
Ketamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced forearm fractures.
Majority of paediatric forearm fracture, irrespective of displacement, can be treated in the ED as long as the fracture pattern is reducible and can be maintained safely in a moulded cast for the duration of its healing.