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Introduction of the Trauma Triage Clinic at a district general hospital: Safety and efficacy during the first year of implementation
ESSKA Academy. Marsland D. Nov 8, 2019; 284442; epESMA-36
Mr. Daniel Marsland
Mr. Daniel Marsland
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Introduction of the Trauma Triage Clinic at a district general hospital: Safety and efficacy during the first year of implementation

ePoster - epESMA-36

Topic: Sports Trauma

Madhusudan N., Lewis T., Kunicki A., Hardie J., Macleod I., Marsland D.
Royal Hampshire County Hospital, Hampshire, United Kingdom

Introduction: In 2013, the British Orthopaedic Association published guidelines on fracture clinic services (BOAST 7) which state that patients who are deemed appropriate should be reviewed by a trauma consultant within 72 hours of injury, either directly or by review of case notes and imaging. Guidelines deviating from recommendations should be prospectively evaluated.
Objectives: The objectives from this study were to assess the safety and efficacy of the trauma triage clinic since its commencement in November 2017, at a district general hospital. The project aimed to assess the diagnosis of rare but easily missed injuries such as Lisfranc fracture/dislocations. Other aims included to review the time to assessment in trauma triage clinic from first presentation, time to fracture clinic, whether patients required operative management and the time to theatre, whether there were delayed or missed diagnoses and complications.
Methods: Data from the trauma triage clinic were retrospectively collected from November 2017 to February 2018, during which 1161 patients were reviewed (mean age 39 years, range 0-96). A database was devised, with details of the patients' demographics, injury details, outcome from trauma triage clinic, complications and missed diagnoses. Case notes and radiographs were reviewed for all patients, and data entered into the database. Statistical analysis was performed using Microsoft Excel.
Results: During the study period 80% of patients were seen in the trauma triage clinic within the 72 hour target. The discharge rate directly from trauma triage clinic was 26%. For those patients referred to fracture clinic (67%), the median time to review was 11 days (range 0-126 days). The operative rate was 2%, with a median time to surgery of 14 days. Seven high risk injuries were missed in the Emergency Department, including one complex carpal instability, three talar fractures, two Lisfranc injuries and one posterior shoulder dislocation. 11 injuries were missed in the trauma triage clinic, including two Lisfranc injuries and one posterior shoulder dislocation.
Conclusion: Initial results show the percentage of patients discharged from trauma triage clinic is similar to previously published work. Further work is required to achieve 100% compliance within the 72 hour target and to improve the detection of high risk injuries, particularly in the foot and ankle which may go unrecognised in the absence of clinical examination.
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