Fast Track for Wrist and Scaphoid Fractures

Study Overview
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Brief Summary
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This is a mono centric, prospective, randomised trial on the implementation and assessment of a shortened pathway for mono-trauma of the wrist and suspected fracture of distal radius and/or ulna and/or scaphoid bone.

Detailed Description
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Patients will be randomised into two groups: fast track and normal pathway. At the arrival in the Emergency Department a triage will be performed. In case of met inclusion criteria the patient will sign the informed consent and will be randomised in one of the two study groups. The fast track group will be straightforwardly evaluated for absence of exclusion criteria (in case of exclusion criteria present the investigators will follow the normal pathway and the patient will not be included in the study). Then, patients will be assessed with an ad hoc checklist and then sent for x-ray performance, if necessary. After the x-ray the patients will be examined by an emergency physician that will have the opportunity to request new x-ray views if necessary. The normal pathway group will go straight to medical examination as soon as possible, depending on waiting times in the Emergency Department. Investigators will collect anagraphical data, waiting times, time to x-ray, overall length of stay in the Emergency Department, patients' and staff's satisfaction for the two groups.

Official Title
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Fast Track in the Emergency Department for Wrist and Scaphoid Fractures: a Randomised Trial

Conditions
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Wrist Fracture, Scaphoid Fracture

Intervention / Treatment
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* Other: fast track
* Other: normal pathway


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adults patients presenting at the emergency dept with suspected scaphoid or wrist fracture monotrauma written informed consent Exclusion Criteria: patients younger than 18 yr pregnant women either vascular or neural impairment signs of open fracture multiple trauma patient

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: fast track<br>patients arriving at Emergency Department with suspected wrist or scaphoid fracture, randomly allocated to the fast track pathway (xray requested at triage by nurse) | Other: fast track<br>* short cut for the request of xrays directly at triage<br>|
| Active Comparator: normal pathway<br>patients arriving at Emergency Department with suspected wrist or scaphoid fracture, randomly allocated to waiting room and than medical examination before asking for xrays | Other: normal pathway<br>* x-ray would be required according to doctor's clinical evaluation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of x rays requested | the number of xray requested | From admission to discharge, up to 2.5 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| waiting time before examination |  | From admission to discharge, up to 2.5 hours | 
| waiting time before xray |  | From admission to discharge, up to 2.5 hours | 
| total length of stay in the emergency department |  | From admission to discharge, up to 2.5 hours | 
| patient's satisfaction | Patients' satisfaction will be tested with the help of the brief emergency department patient satisfaction scale (BEPSS). The questionnaire consists of 20 questions and for each item, a response scale form 1 (completely disagree) to 4 (completely agree) is used. | From admission to discharge, up to 2.5 hours |