Assessing referral appropriateness for torus (buckle) and minimally displaced clavicle fractures to a paediatric virtual fracture clinic.
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All Authors
Roberts E.
Deriu L.
LTHT Author
Deriu, Laura
LTHT Department
Leeds Children's Hospital
Paediatric Orthopaedics
Paediatric Orthopaedics
Non Medic
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
PAEDIATRICS , UNITED KINGDOM , HOSPITALS , PATIENT SAFETY , ORTHOPAEDICS , FRACTURES, BONE , CLINICAL AUDIT , Quality Improvement
Subject Headings
Abstract
Background Local guidance advises first-contact discharge with safety-netting for torus (buckle) fractures and minimally displaced clavicle fractures (MDCF). This aligns with NICE NG38 and the UK multicentre FORCE randomised trial showing that soft bandage/no routine follow-up is safe and effective for torus fractures. Despite this, our Virtual Fracture Clinic (VFC) has flagged frequent referrals of these injuries, potentially creating avoidable activity. Method(s): Retrospective audit of all paediatric VFCreferrals at a large UK teaching hospital during June- September 2023 and June-September 2024. Electronic records (PPM+) were screened to identify children with torus fracture or MDCF who were discharged at VFCwithout additional intervention. Cases needing further management were excluded. Primary outcomes: (i) proportion of all VFCreferrals that were buckle/clavicle fractures (BFC); (ii) among BFC, the proportion originating from the hospital's paediatric emergency department (ED). Secondary outcome: Overall share of ED-originating BFCas a percentage of all VFCreferrals. Result(s): 2023 (n = 1,050 referrals): 9.52% were BCF; 5.05% of all VFCreferrals were ED-originating BCF (53 contacts). 2024 (n = 1,174): 8.52% were BFC; 4.94% were ED-originating BFC(58 contacts). Year-to-year share was similar (-0.11 percentage points). Findings indicate persistent referrals to VFCfor injuries intended for first-contact discharge. Conclusion(s): There is a clear gap between protocol and practice, generating avoidable VFCactivity. We are implementing a multi-component quality-improvement package: Revised parent/carer materials and safety-netting, refined age/red-flag criteria, and targeted ED teaching. Service goal: Reduce ED-originating BFC->VFCreferrals by >=50% within 6 months of implementation while monitoring unplanned reattendance. This pathway optimisation is low-cost, scalable, and likely generalisable to similar VFCmodels internationally. Governance: Retrospective service evaluation using anonymised data; no formal ethics required under local policy.
Journal
Critical Public Health