A new study published in JAMA Network Open aimed to assess how often children younger than 10 years undergo a potentially unnecessary closed reduction using procedural sedation in the emergency department for distal radial metaphyseal fracture, and the associated cost implications for these reduction procedures.

This was a retrospective cross-sectional study that included 258 consecutive children younger than 10 years, who presented to a pediatric emergency department and had a distal radius fracture with or without ulna involvement, from 2016-2017. Reductions were deemed to be potentially unnecessary if coronal and sagittal plane angulations of the radius bone measured less than 20° and shortening measured less than 1 cm on initial injury radiographs.

Overall, 60% of the participants were males. Among the 142 children who underwent closed reductions with procedural sedation in the emergency department, 27% procedures were considered potentially unnecessary. Review of Common Procedural Terminology charges estimated an approximately $7000 difference between the stated cost of a reduction procedure in the emergency department versus a cast application in an outpatient orthopedic clinic for distal radial metaphyseal fractures. The mean (SD) maximal angulation in either plane for fractures that underwent appropriate reduction was 30.6° (10.3°) compared to 13.9° (4.5°) for those unnecessarily reduced. Meanwhile, patients who were transfers from other facilities were more than twice as likely to undergo a potentially unnecessary reduction.

From the results, it was concluded that an improved awareness of these deformities in young children may be associated with limiting the number of patients requiring reduction with sedation, improving the pediatric emergency department efficiency, and substantially reducing health care costs.

Source: JAMA Network Open. 2020 Feb 5;3(2):e1921202. doi: 10.1001/jamanetworkopen.2019.21202.