• J Emerg Med · May 2024

    Rate of Successful Shoulder Reduction on First Confirmatory Imaging in the Emergency Department.

    • Jeffrey R Stowell, Levi Filler, Carl Mitchell, Ashkon Mahmoudi, Thomas Whiting, Carl Pastore, Matthew Kunz, and Murtaza Akhter.
    • Creighton University School of Medicine (Phoenix) Program- Emergency Medicine, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona.
    • J Emerg Med. 2024 May 1; 66 (5): e555e561e555-e561.

    BackgroundManagement of acute shoulder dislocation in the emergency department (ED) is common.ObjectiveThis study describes the rate, risk factors, and length of stay (LOS) associated with shoulder dislocation reduction failure in the ED.MethodsThe study was a retrospective case-control study of patients 18 years and older presenting to the ED with acute shoulder dislocation who underwent attempted reduction. Patients with successful reduction on post-reduction first confirmatory imaging are compared with those requiring multiple attempts.ResultsOf 398 ED encounters when a shoulder reduction was attempted in the ED, 18.8% (75/398 [95% CI 15.2-22.9%]) required multiple reduction attempts. Patients with successful reduction on first confirmatory imaging were more commonly male (80.2% [95% CI 75.6-84.3%] vs. 68.0% [95% CI 56.8-77.8%]; p = 0.0220), discharged home from the ED (95.4% [95% CI 92.6-97.3%] vs. 84.0% [95% CI 74.4-91.0%]; p = 0.0004), reduced using a traction/countertraction technique (42.1% [95% CI 36.8-47.6%] vs. 29.3% [95% CI 19.9-40.4%]; p = 0.0415), and less likely to have a pre-reduction fracture (26.0% [95% CI 21.4-31.0%] vs. 45.3% [95% CI 34.4-56.7%]; p = 0.0010). Mean length of stay (LOS) for those with successful reduction on first confirmatory imaging was 2 hours and 8 minutes shorter than for those with more than one attempt (p < 0.001).ConclusionsThe rate of failed first-pass reduction is higher than previously reported. Furthermore, the ED LOS was significantly longer in patients requiring multiple attempts. Knowledge of the failure rate and risk factors may raise physician awareness and guide future studies evaluating approaches for verification of reduction success.Copyright © 2024 Elsevier Inc. All rights reserved.

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