The Effects of a Direct Discharge Protocol in Children with a Bicycle Spoke Injury

Background: Direct discharge (DD) from the emergency department (ED) may provide an efficient treatment option for children with a bicycle spoke injury.Although DD has been widely implemented in the Netherlands, injury specific results are lacking.This study aimed to assess the effects of DD on the treatment of children (aged <12 years) with a bicycle spoke injury compared to traditional treatment. Patients and Methods:In this retrospective cohort study, patients aged <12 years with a bicycle spoke injury treated between January 2018 and November 2020 were included.Outcomes included secondary healthcare utilization, protocol compliance, ED reattendances and hospital treatment costs.Patient-reported outcomes and primary healthcare utilization were evaluated via an online questionnaire. Results:The pre-DD group consisted of 102 patients and the DD group of 121.DD resulted in fewer follow-up appointments (median:1, range:3) compared to pre-DD treatment (median:0, range:4).Protocol compliance by ED caregivers was 86% in pre-DD patients vs. 88% in DD patients.ED reattendances were low and comparable in both groups.DD consequently resulted in a reduction of calculated hospital treatment costs.No persistent functional limitations or shift to primary healthcare were reported. Conclusions:In this study, treatment of children (aged <12) with a bicycle spoke injury through DD reduced secondary healthcare utilization compared to traditional treatment, with a high protocol compliance rate.DD did not increase ED reattendances or negatively affect treatment outcomes.