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The use of esketamine sedation in the emergency department for manipulation of paediatric forearm fractures: A 5 year study.

Authors
  • Patel, Dhawal1
  • Talbot, Christopher2
  • Luo, Weisang3
  • Mulvaney, Shirley4
  • Byrne, Eileen4
  • 1 Department of Orthopaedics, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, United Kingdom. Electronic address: [email protected] , (United Kingdom)
  • 2 Department of Orthopaedics, Alder Hey Children's NHS Foundation Trust, East Prescot Road, Liverpool, L14 5AB.
  • 3 Department of Orthopaedics, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, United Kingdom. , (United Kingdom)
  • 4 Department of Emergency Medicine, Alder Hey Children's NHS Foundation Trust, East Prescot Road, Liverpool, L14 5AB.
Type
Published Article
Journal
Injury
Publication Date
Jun 01, 2021
Volume
52
Issue
6
Pages
1321–1330
Identifiers
DOI: 10.1016/j.injury.2020.12.033
PMID: 33454059
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The purpose of this study is to assess the use of esketamine as procedural sedation for the reduction of paediatric forearm fractures in the emergency department (ED). A retrospective analysis was undertaken of forearm fractures between 1st January 2012 to 31st December 2016 which were treated with manipulation in ED using esketamine sedation. Patient demographics and fracture configuration were collected. Patient radiographs were evaluated and cast index calculated. 151 patients (103 male, 48 female) were included (average age of 8.5 [1 to 15]). Four (2.6%) patients were lost to final follow up. 11 (7%) fractures were not accepted after initial manipulation and required formal surgical management under general anaesthetic. At one week follow up, a further 5 (3%) fractures displaced requiring operative management. 100% of patients who slipped at one week had a cast index greater than 0.8 [average 0.86, 95% CI 0.80-0.92]. At final follow up successful reduction was achieved in 89.1% (131/144) of patients. No adverse events occurred following administration of esketamine. This study provides evidence that manipulation of paediatric forearm fractures using esketamine as procedural sedation in the ED is comparable to other methods in achieving acceptable outcomes. This is in addition to the potential for cost savings. However, future studies formally assessing cost effectiveness and patient outcomes are needed. Copyright © 2021. Published by Elsevier Ltd.

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