Audit of nasal fracture management in accident and emergency in a district general hospital.
BACKGROUND
Nasal fractures are a common occurrence in accident and emergency and dealt with by inexperienced senior house officers. This can lead to inappropriate X-rays being performed, no proper documentation of septal haematomas and often no follow-up with a specialist team leading to in some cases complex cosmetic surgery whereas simple manipulation may have sufficed.


METHODS
We report an ambispective audit carried out on nasal fracture management in a busy district general hospital over a 6-month period.


RESULTS
46 patients were seen 24 in the first 3 months and 22 the next three. 10 had nasal X-ray performed initially on audit. Nine had no documentation of septal haematoma and seven had no follow-up arranged. After appropriate education and the setting up of a department protocol based on best practice, the next cycle was repeated. Two nasal X-rays were performed looking for foreign bodies, all patients had appropriate documentation of septal haematoma and appropriate follow-up.


CONCLUSIONS
Appropriate education and implementation of departmental guidelines can result in more effective and efficient use of resources when dealing with nasal fractures in accident and emergency.
Agrawal
Namit
N
ENT Surgery, Guy's and St Thomas' NHS Trust, London, UK. namitagrawal@yahoo.com
Brayley
Nigel
N
D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries*; D006113:United Kingdom