Sedation for Forearm Fracture Reduction in the Pediatric Emergency Department: Impact on Hospitalization and Length of Stay

Background: Children with forearm fractures who present to the emergency department (ED) often need a dosed reduction. In our institution, until 2017, pediatric trauma patients presented to the general trauma ED (GTED) where no sedation services for pediatric patients were available. From 2017, patients present-ed to the pediatric emergency department (PED) where closed reductions were performed under sedation when appropriate. Objectives: To compare GTED and PED with regard to length of stay (LOS) and hospitalization rates of pediatric patients with forearm fractures who needed a closed reduction. Methods: Our retrospective observational study was conduct-ed at a regional hospital. The study population consisted of all patients younger than 18 years of age who presented to the ED with a forearm fracture that needed a closed reduction. The primary outcome measure was the hospitalization rate. The secondary outcome measure was LOS in the ED. Results: The study comprised 165 patients with forearm frac-tures who needed a closed reduction; 79 presented to the GTED and 96 presented to the PED. Hospitalization rates were lower for patients undergoing closed reduction under sedation in the PED compared to the GTED (6.3% and 21.5%, respec-tively; P = 0.003). Median ED LOS was longer among patients undergoing sedation in the PED compared to the GTED (237 vs. 168 minutes respectively, P< 0.0001). Conclusions: Sedation for forearm fracture reduction in a hospital's PED was associated with a decrease of more than three times in hospitalization rate. Despite the need for more resources, PED LOS was only mildly increased. IMAJ 2023; 25: 265-267