The Children’s Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED) project

Aims: This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally. Methods: This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital. Results: Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge. Conclusion: This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.