Clinical trial NCT06445218: Observational Study of Musculoskeletal Patients in an Emergency Department in France
Official title: Observational Study of Musculoskeletal Patients in an Emergency Department in France : a Pilot Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Musculoskeletal Pain
Keywords: Emergency department
musculoskeletal disorder
Lead sponsor: Hôpital NOVO
Sponsor class: OTHER
Collaborators: name: University of Brighton
First posted: 2024-06-06
Enrollment: 161
Sex: ALL
Minimum age (years): 18
Maximum age (years): 68
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients suffering from musculoskeletal disorders in an emergency department

Brief summary: The purpose of this study is to estimate the number of patients who come to the emergency department with a musculoskeletal referral, to describe the different types of diagnosis for these patients and their treatment and discharge.

Detailed description: There is a crisis in the emergency department (ED) in France, as their number of consultations have constantly increased over the past ten years . Musculoskeletal disorders (MSK) are the most common cause of consultations in ED, as an example there is an average of 30% of ED consultations being for traumatic issues . Moreover, 90% of all patients coming in ED in France have a favourable prognosis of evolution (no risk of seriousness). In this situation, one of the propositions to help to reduce the ED burden is to allow a direct access to physiotherapists. They are the recommended profession to treat patients for musculoskeletal conditions and several studies showed physiotherapy assessment and treatment in an emergency service is safe and beneficial both for the patients and the hospital teams. They have reported to increase satisfaction, to reduce medications and requirement for expensive imaging on one hand, and to reduce the costs and to give more time to the medical team on the other hand This role does not exist yet in France, although more than 48 countries across the world have implemented it, and French physiotherapists are advocating for it. A recent text has been adopted by the French government allowing patients with recent ankle sprain or low back pain to self-refer to physiotherapists working in hospitals or in care home. . However, this access is very restricted, which will make the implementation difficult as it might not be sufficient to assist the ED. Moreover, there is a lack of information on the number and the type of diagnostic of patients with a MSK label coming to the ED, which makes it difficult to assess the impact this role could have on French ED.

In this context, a retrospective survey, describing how many patients with a musculoskeletal label are coming to the ED, and how they are managed, could help to estimate the worthiness of physiotherapist direct access in French ED.

Question : What is the proportion, the type of diagnostic and the management of musculoskeletal disorder in emergency department in one hospital in France?

Eligibility criteria: Inclusion Criteria :

* Patients aged between 18 and 68
* Patients admitted to emergency with a triage by the Reception and Referral Nurse of 0, 1 or 2
* Patients who consulted for one of the following reasons:

Lower limb pain (T13.9) Lower limb trauma (M79.61) Upper limb pain (T11.9) Upper limb trauma (M79.60) Spinal pain (M54.9) Lumbar or flank pain (R10.3) Diffuse/unspecific pain (R52.9) Loss of sensitivity/paraesthesia

- Patients informed of the study and who did not object

Exclusion Criteria :

* Patients with another reason for consultation associated with the first
* Patients under guardianship / curatorship and patients under safeguard of justice.

Primary outcomes:
measure: Description of the population (diagnoses and treatment) considered to have a potential musculoskeletal disorder after nursing triage
timeFrame: At the end of the study, an average of 3 month
Secondary outcomes:
measure: Description of the management of patients (duration) with a potential musculoskeletal disorder after nursing triage
timeFrame: At the end of the study, an average of 3 month
measure: Description of the management of patients (number of patients per day of the week) with a potential musculoskeletal disorder after nursing triage
timeFrame: At the end of the study, an average of 3 month
measure: Description of the management of patients (end-of-care orientation) with a potential musculoskeletal disorder after nursing triage
timeFrame: At the end of the study, an average of 3 month
measure: Assessment of the prevalence of people with a potential musculoskeletal disorder after nursing triage
timeFrame: At the end of the study, an average of 3 month
Other outcomes:
Locations:
city: Pontoise
country: France
facility: Emergency Service - Hôpital NOVO - Pontoise site
Study officials:
affiliation: Hôpital NOVO
name: Benoit ANCEL
role: PRINCIPAL_INVESTIGATOR
References:
citation: Babatunde OO, Bishop A, Cottrell E, Jordan JL, Corp N, Humphries K, Hadley-Barrows T, Huntley AL, van der Windt DA. A systematic review and evidence synthesis of non-medical triage, self-referral and direct access services for patients with musculoskeletal pain. PLoS One. 2020 Jul 6;15(7):e0235364. doi: 10.1371/journal.pone.0235364. eCollection 2020.
citation: Demont A, Quentin J, Bourmaud A. [Impact of models of care integrating direct access to physiotherapy in primary care and emergency care contexts in patients with musculoskeletal disorders: A narrative review]. Rev Epidemiol Sante Publique. 2020 Sep;68(5):306-313. doi: 10.1016/j.respe.2020.08.001. Epub 2020 Sep 3. French.
citation: Demont A, Bourmaud A, Kechichian A, Desmeules F. The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature. Disabil Rehabil. 2021 Jun;43(12):1637-1648. doi: 10.1080/09638288.2019.1674388. Epub 2019 Oct 11.