ArticleTrauma surgery & acute care open2021
Direct discharge from the emergency department of simple stable injuries: a propensity score-adjusted non-inferiority trial.
Article in Trauma surgery & acute care open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Self-Management Exercise Regimen Versus Supervised Hand Therapy in Patients With Dorsal Dislocation or Hyperextension Injury With a Volar Plate Avulsion of the Proximal Interphalangeal Joint: The Randomized Controlled PINOT Study.Hand (New York, N.Y.) · 2026Article
- Radiological follow-up in metacarpal fractures: necessity, costs, and environmental impact.Skeletal radiology · 2026Article
- Rate, Mode, Reasons and Factors Associated With Re-Presentation in People Diagnosed With Musculoskeletal Conditions at a Single Emergency Department: A Cross-Sectional Exploratory Study.Emergency medicine Australasia : EMA · 2025Article
- Beyond the emergency department: the use of mobile health discharge interventions-a scoping review.CJEM · 2025Article
- Efficiency of a virtual fracture clinic review protocol in adult patients with distal radial fractures requiring semi-acute surgical treatment.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- The impact on time between injury and semi-acute surgery for hand fractures after virtual fracture clinic implementation.The Journal of hand surgery, European volume · 2025Article
- The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring semi-acute surgery: a retrospective cohort study.Frontiers in digital health · 2024Article
- Cost-effectiveness of direct discharge from the emergency department of patients with simple stable injuries in the Netherlands.Trauma surgery & acute care open · 2021Article
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Authors and funding
7 authors.
Funding
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Abstract
backgroundRecent studies suggest a large proportion of musculoskeletal injuries are simple stable injuries (SSIs). The aim of this study was to evaluate whether direct discharge (DD) from the emergency department (ED) of SSIs is non-inferior to 'traditional care' regarding treatment satisfaction and functional outcome, and to compare other patient-reported outcomes (PROMs), patient-reported experiences (PREMs), resource utilization, and adverse outcomes before and after DD.
methodsThis trial compared outcomes for 11 SSIs 6 months before and after the implementation of DD protocols. Pre-DD, patients were treated according to local protocols. Post-DD, patients were discharged directly using removable orthoses, discharge leaflets, smartphone application, and telephone helpline. Participants received a 3-month postinjury PROM/PREM survey to assess treatment satisfaction (Visual Analog Scale, VAS), pain (VAS), functional outcome (four validated questionnaires), and health-related quality of life (HR-QoL; EuroQol-5D). Resource utilization included general practitioner (GP) visit (yes/no), physiotherapist visit (yes/no), return to work/school/sports (days), work/school absenteeism to visit hospital (yes/no), number of hospital visits, and follow-up X-rays. Other outcomes included missed injuries (additionally to SSI) and adverse outcomes (delayed union, non-union). Between-group differences were assessed using propensity score-adjusted regression analyses. Non-inferiority was assessed for satisfaction and functional outcome using predefined margins.
results348 (pre-DD) and 371 (post-DD) patients participated; 144 (41.4%) and 153 (41.2%) patients completed the survey. Satisfaction and functional outcome post-DD were non-inferior to traditional care. Mean satisfaction was 8.13 pre-DD and 7.95 post-DD (mean difference: -0.16, p=0.408). Pain, HR-QoL, GP/physiotherapist visits, and return to work/school/sports were comparable before and after DD. Work absenteeism was higher pre-DD (OR 0.110, p<0.001), as well as school absenteeism (OR 0.084, p<0.001). Post-DD, the mean number of hospital visits and X-rays reduced: -1.68 (p<0.001) and -0.26 (p<0.001). Missed injuries occurred once pre-DD versus twice post-DD. There were no adverse outcomes. DISCUSSION: The results of this study confirm several SSIs can be discharged directly from the ED without compromising patient outcome/experience. Future injury-specific trials are needed to conclusively assess non-inferiority of DD. LEVEL OF EVIDENCE: II.
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