In 2014, a study has explored the capability of triage nurses in emergency departments to treat radial-head subluxation—a common and easily treatable injury in young children—effectively, comparing their performance to that of physicians. The findings, while somewhat mixed, are promising.

Conducted by Andrew Dixon and colleagues, the cluster-randomized controlled trial focused on children aged six years and younger who presented with symptoms of radial-head subluxation following a known injury within the past 12 hours. The study split the young patients into two groups: one treated by triage nurses and the other by emergency department physicians.

The primary objective was to determine the proportion of children who achieved successful reduction, defined as the return to normal arm usage. Researchers set a noninferiority margin at 10%, aiming to establish whether nurses could perform reductions nearly as effectively as physicians.

Out of 268 eligible children, 245 were included in the final analysis. The results showed that 96.7% (117 out of 121) of the children treated by physicians experienced successful reductions. In contrast, the nurse-treated group had an 84.7% success rate (105 out of 124). The difference in success rates between the two groups was 12.0%, with a 95% confidence interval ranging from 4.8% to 19.7%.

While the nurses’ performance did not meet the stringent noninferiority margin, their success rate of nearly 85% is noteworthy. The study concluded that although nurse-initiated reductions were inferior to those performed by physicians, nurses still effectively treated a significant majority of children with probable radial-head subluxation.

These findings suggest that with additional training and support, nurses could become more adept at treating this common pediatric injury. This potential shift could ease the burden on emergency physicians and expedite care for young patients, making the emergency department more efficient and responsive.

Reference: Dixon, A., Clarkin, C., Barrowman, N., Correll, R., Osmond, M. H., & Plint, A. C. (2014). Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial. Cmaj, 186(9), E317-E323.