EXAMINATION AND DOCUMENTATION OF NEUROVASCULAR STATUS IN UPPER LIMB TRAUMA

Background

The British Orthopaedic Association Standards for Trauma (BOAST) for peripheral nerve injuries¹ states:

“A careful examination of the peripheral nervous and vascular systems must be performed and clearly recorded for all injuries. This examination must be repeated and recorded after any manipulation or surgery.”

This study investigated whether this standard was met for patients with upper limb trauma at a busy London Accident and Emergency (A&E) Department.

Method

Data was gathered prospectively from A&E admission notes for 30 consecutive patients with upper limb injuries from the week beginning 11^th March 2013.

Eligibilty: All patients with upper limb injuries.

Results

30 patients: 18 Males mean age of 39.2 and 12 Females mean age of 40.1.

17 patients (56.6%) had documentation of examination of neurovascular status.

14 patients required manipulation and/or splinting of their injury. Of these, no patients had their neurovascular examination documented after the procedure. Poor adherence to the standard is evident across all grades of doctors: FY2, SHO and SpR.

Conclusion

There is clear scope to improve documentation of neurovascular status in upper limb injuries. It is especially important to clearly document neurovascular status following manipulation or splinting from a medico-legal perspective. This applies to all grades of staff in A&E.

Recommendations

1. 1.

   Education of A&E staff of all grades at the departmental induction

2. 2.

   Posters in A&E with simple treatment algorithm for managing fractures and dislocated joints

3. 3.

   Re-audit in 6 months