X-rays Trauma Request's by the Triage And Intake Nurse Intake and Referral Nurse:

Limb Injury Clinical Trial

— DARIO  

Official title:

X-rays Trauma Request's by the Triage And Intake Nurse Intake and Referral Nurse: X-TRAIN Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05669157
• Other study ID #: CHRO-2022-08
• Status: Completed
• Phase: N/A
• Start date: January 16, 2023
• Est. completion date: June 25, 2023

Study information

• Verified date: July 2023
• Source: Centre Hospitalier Régional d'Orléans
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 400
• Est. completion date: June 25, 2023
• Est. primary completion date: June 25, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 15 Years to 80 Years

Eligibility

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

Related Conditions & MeSH terms

• Limb Injury

Intervention

Procedure:
• Radiography request by nurse
Intervention group with radiography requested by the IRN instead of the physician. The radiography will be interpreted by the physician afterwards, according to current practice
• Radiography request by physician
The physician prescribed the X-ray, the X-ray technician carries out the imagery and the physician interprets it afterwards

Locations

Country	Name	City	State
France	CHR d'Orléans	Orléans

Sponsors (1)

Lead Sponsor	Collaborator
Centre Hospitalier Régional d'Orléans

Country where clinical trial is conducted

France, 

References & Publications (1)

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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Duration between triage and exit of emergency unit	Total duration in minutes in the emergency department with or without anticipated request of X-ray	immediatly after the procedure
Secondary	Total duration of the stay	Total duration in minutes in the emergency department	immediatly after the procedure
Secondary	Number of additional X-ray prescribed by the physician after physician assessment.	Number of new X-ray images taken after physician assessment.	immediatly after the procedure
Secondary	Appropriateness of the X-rays requested by the IRN as per guidelines	Number of new X-ray images taken after physician assessment.	immediatly after the procedure
Secondary	IRN's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)	Quality of life questionnaire. Min: not satisfied; max : satisfied	immediatly after the procedure
Secondary	X-ray technician's feeling about the anticipated request for X-ray (assessed as per anonym Quality of Life at Work questionnaire)	Quality of life questionnaire. Min: not satisfied; max : satisfied	immediatly after the procedure
Secondary	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)	Quality of life questionnaire. Min: not satisfied; max : satisfied	immediatly after the procedure