118 Knee Immobilizer Use in the Emergency Department

Abstract

Assess the prescription of knee immobilizers by emergency department providers. Assess if educational interventions describing appropriate prescription of knee immobilizers changes the prescription patterns of emergency department providers. Knee pain is one of the most common presenting complaints to emergency departments in the United States. Patients are frequently prescribed knee immobilizers despite not meeting adequate criteria (evidence of ligamentous instability, presence of a tibial plateau fracture, patellar fracture, patellar dislocation, acute traumatic joint effusion). Inappropriate use of knee immobilizers pose a risk of muscle atrophy, joint stiffness, increased risk of DVT, and prolonged patient recovery. Many providers are likely unaware of the risks posed by immobilizers and the appropriate indications for use. A retrospective chart review was performed at four different urban academic hospitals in NYC using each institution’s respective electronic medical record system. Each system queried adult and pediatric patient visits in the emergency department in which a knee immobilizer was prescribed and the patient was discharged. Exclusion criteria included patients admitted to the hospital. Chart review was performed from January 1, 2011- December 31, 2012. The intervention arm included lectures describing appropriate indications for knee immobilizer. The lectures were both in person and an online video format given to providers at each academic institution during March-June 2016. There is ongoing chart review from July 1, 2016- June 30, 2017. Chart review from 2011 to 2012 is summarized in Table 1.Tabled 1Table 1. Chart review data from 2011-2012InstitutionKnee Immobilizers PrescribedCorrectly PrescribedInappropriately PrescribedA437210227B1579067C10555535520D856442414 Open table in a new tab Data collection is ongoing; however, there is preliminary data from July 1, 2016 to Dec 31, 2016, summarized in Table 2.Table 2Chart review data from July 1, 2016 to December 31, 2016.InstitutionKnee Immobilizers PrescribedCorrectly PrescribedInappropriately PrescribedA775918B613922C775522D917615 Open table in a new tab Knee immobilizer use in the ED was not indicated in almost 50% of the patients who received them. Data collection is still ongoing for part 2 of the study, but shows a trend toward a decreasing percentage of inappropriately prescribed knee immobilizers.