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van CCT (UK)

van CCT (UK)

Implementation of the APWR by the ED triage nurse

- candidate number27776
- NTR NumberNTR6642
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR22-aug-2017
- Secondary IDsW17_220 # 17.259 METC van het Academisch Medisch Centrum Amsterdam
- Public TitleImplementation of the APWR by the ED triage nurse
- Scientific TitleThe Amsterdam Pediatric Wrist Rules, an implementation study by the emergency department triage nurse
- hypothesisWith implementation of the APWR by the ED triage nurse we expect a reduction in the total number of radiographs requested, without missing any clinical relevant fractures. We also expect a reduction in overall waiting times at the ED and cost savings.
- Healt Condition(s) or Problem(s) studiedWrist, Trauma , Distal radius, Decision-making, Implementation, Ulna
- Inclusion criteriaAll consecutive patients from 3 to 18 years presenting with an acute trauma of the wrist at the Emergency Department.
- Exclusion criteria- The injury occurred more than 72 hours previous to the presentation at the Emergency Department
- Patients who sustained multiple injuries with an Injury Severity Score (ISS) more than 15
- Patients whose X-rays were requested previous to their visit to the Emergency Department (for example by their general practitioner)
- A wrist fracture in the past 3 months
- Patients with an unreliable examination (e.g. intoxicated patients)
- mec approval receivedyes
- multicenter trialyes
- randomisedno
- groupParallel
- TypeSingle arm
- Studytypeobservational
- planned startdate 1-okt-2017
- planned closingdate1-okt-2018
- Target number of participants150
- InterventionsUse of the APWR.
- Primary outcomeThe number of requested radiographs in children with acute trauma of the wrist after implementation of the AWR.
- Secondary outcome- The number of clinically relevant missed fractures of the distal radius and distal ulna in children after implementation of the APWR
- The reduction of overall lenght of stay at the ED
- Physician compliance with the APWR
- Cost analysis of the APWR
- TimepointsOutcomes will be evaluated at the end of the inclusion period.
- Trial web
- statusplanned
- Sponsor/Initiator Academic Medical Center (AMC), Amsterdam
- Funding
(Source(s) of Monetary or Material Support)
Academic Medical Center (AMC), Amsterdam
- PublicationsSlaar A, Walenkamp MM, Bentohami A, Maas M, van Rijn RR, Steyerberg EW, et al. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules. Pediatric radiology. 2016;46(1):50-60.
- Brief summaryIn most hospitals, children with wrist trauma are routinely referred for radiography of the wrist. However, only 51% has a fracture of the wrist. Currently, no clinical guidelines are imbedded in daily practice on Emergency Departments (ED) to decide if a wrist radiograph is necessary. This may result in unnecessary radiographs and therefore increased time spent at the ED, increased workload, and additional healthcare costs. Encouraged by the theoretical overuse of radiological resources due to the lack of clinical guidelines a clinical decision rule for children has been develop: the Amsterdam Pediatric Wrist Rules. The APWR has been externally validated and recently also implemented at the EC by emergency physicians. . However, in the recently finished implementation study, the EDs had to change their workflow because patients were first seen by the ED physician and not the triage nurse. Therefore, the aim of the current study is to evaluate the effect of the implementation of the APWR by ED triage nurses and to evaluate if this leads to the same reduction in wrist radiographs.
- Main changes (audit trail)
- RECORD22-aug-2017 - 31-aug-2017

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