Shoulder Dislocation in the Emergency Department: Experience within a Large District General Hospital

Abstract

Objectives: To evaluate the incidence of shoulder dislocation, age and gender distribution, success and failure rate following attempts at reduction in the ED and factors associated with failed reduction. Secondary outcome measures include type and number of medications required for successful reduction and complications associated with reductions attempts.

Methodology: A retrospective chart review of all patients presenting to the Emergency department with shoulder dislocation within the study period was undertaken. The study was undertaken over a one-year period from 1st December 2018 to 30th November 2019 within the ED of a large DGH that receives approximately 100,000 attendances per annum. Data was extracted on to a proforma including patient demographics, type of dislocation, number of attempts at reduction and complications. The data was reviewed and analysed by two of the study authors.

Results: We found an incidence of shoulder dislocation of 16.5 per 100,000 attendances (less that 1% of ED) presentations per annum. The mean age was 58.8 years. There was a male preponderance in terms of gender distribution with males making up 67% and females 33%. There was a peak incidence in men within the age range 21-30 years.  There was a 76% (n=25) successful reduction rate in the ED.

Attempts at reduction failed in 8 cases (24%). The mean age of the failed reduction group was 46.5 years (95% CI, 24.96-58.79). It was 61.6 years (95% CI, 57.3-75.2) in the successful reduction group. The use of morphine, paracetamol and sedation were associated with successful reduction. All failed reduction attempts required general anaesthesia to achieve reduction.