Clinical trial NCT05669157: X-rays Trauma Request's by the Triage And Intake Nurse Intake and Referral Nurse:
Official title: X-rays Trauma Request's by the Triage And Intake Nurse Intake and Referral Nurse: X-TRAIN Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Limb Injury
Keywords: Traumatology
Personnel delegation
Nurse specialists
Radiography
emergency department
intake and referral nurse
Lead sponsor: Centre Hospitalier Régional d'Orléans
Sponsor class: OTHER
First posted: 2022-12-30
Enrollment: 400
Sex: ALL
Minimum age (years): 15
Maximum age (years): 80
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The number of consultations in emergency departments is increasing day by day, and the time to treat patients is getting longer. Different French studies have shown a significant reduction in the time spent in the emergency department after the implementation of the national protocol for the delegation of early radiography prescriptions. The investigators hypothesised that an early request for a standard X-ray by the intake and referral nurse in the case of isolated trauma to the extremities of a limb (from the knee to the toes and from the shoulder to the fingers) enables a reduction in medical management time and, consequently, in the time spent in the emergency department for the patient.

Detailed description: This study is divided into two steps to three month.

* The first step of the study corresponds to the current standard of care (SoC) in the emergency department of Orléans. In this first step, the intake and Referral Nurse (IRN) will carry out the usual triage and refer the participant to the appropriate emergency department before being appointed by the physician. The radiography will be requested after the medical consultation.
* In the second step, the intake and referral nurse will carry out the usual triage and then request one, or more, radiography(ies) depending on the standard protocol. This ensures that the physician has access to the imaging before the consultation with the patient. If necessary, the X-ray technician is authorized to refuse the exams or complete the request, the choice of the incidence is up to him/her according to the intake and referral nurse.

Eligibility criteria: Inclusion Criteria:

* Patient older than 15 years and 3 months admitted in adult emergency department of regional hospital center of ORLEANS with a simple and isolated trauma having occurred less than 48 hours prior to admission of a limb extremity (from the knee to the toes or from the shoulder to the fingers), and with no previous imagery assessment within 48 hours prior to admission in the emergency department.

Exclusion Criteria:

* Multiple trauma
* Patient with at least one Vittel criteria (except age)
* Patient refusing the protocol
* Hemodynamic instability and/or disorder of consciousness
* Sensory and/or vascular disorders downstream of the traumatized area
* Protected population (under guardianship or curators)
* Patient under court protection
* Pregnant or breastfeeding woman or one who declares herself to be pregnant or breastfeeding
* Patient with an expired blood alcohol level \> 0.4 mg/L and/or positive blood alcohol level
* Patient with diagnosed dementia
* Patient hospitalized after being taken in charge

Primary outcomes:
measure: Duration between triage and exit of emergency unit
timeFrame: immediatly after the procedure
Secondary outcomes:
measure: Total duration of the stay
timeFrame: immediatly after the procedure
measure: Number of additional X-ray prescribed by the physician after physician assessment.
timeFrame: immediatly after the procedure
measure: Appropriateness of the X-rays requested by the IRN as per guidelines
timeFrame: immediatly after the procedure
measure: IRN's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)
timeFrame: immediatly after the procedure
measure: X-ray technician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)
timeFrame: immediatly after the procedure
measure: Physician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire) Physician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)
timeFrame: immediatly after the procedure
Other outcomes:
Locations:
city: Orléans
country: France
facility: CHR d'Orléans
Study officials:
affiliation: Regional Hospital center of ORLEANS
name: Vincent GARROUSTE, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Lindley-Jones M, Finlayson BJ. Triage nurse requested x rays--are they worthwhile? J Accid Emerg Med. 2000 Mar;17(2):103-7. doi: 10.1136/emj.17.2.103.