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Master Thesis

Enquête de pratiques professionnelles auprès des médecins exerçants aux urgences de Nouvelle Aquitaine au sujet des techniques de réduction de la pronation douloureuse de l’enfant

Abstract : Background and aim: the nursmaid’s elbow (NE) is an extremely common traumatic pathology in children for which there are two reduction techniques: the classic supination- flexion (SF) and the least known forced pronation (FP) which would be more effective. The objectives of the study were to measure the prevalence of the use of these techniques by emergency doctors and their knowledge. Method: the study took place from the 1st January to the 1st June 2019, with a questionnaire sent to physicians working in an emergency department from Nouvelle Aquitaine. This allowed to collect the technique used (SF, FP or both) and to assess medical skills about the NE through their theoretical knowledge and level of mastery of the reductive techniques. Results: only 4% of physicians use FP, while 11% consider it more effective. 55% have received training on NE but 34% have good skills. Almost all physicians received training on reduction technique per SF (97.1%) but very little on FP (19%). Paradoxically, self-trained physicians have better skills than those with specific NE training. Also, we find the same level of skills that doctors have or have not received training. On the other hand, 67% of physicians who have reduced less than 5 NE have mastered the technique they use, and this mastery is similar in emergency doctors who have been practicing for less than 2 years and more than 10 years. Discussions: extremely few doctors use exclusively the FP maneuver which would be the most effective. Nevertheless, this is a rapid learning technique and its mastery seems to be preserved over time. This study shows that emergency doctors would have poor skills and be poorly trained in this pathology, which would explain the lack of use of the FP. Conclusion: this study shows that emergency department physicians primarily use the least effective reduction technique and that there are gaps in their training. It would therefore be useful to improve the teaching of this paediatric pathology in the training of current and future emergency doctors, particularly with the establishment of the emergency medicine DES. We propose a decision algorithm for medical management of a PD in the emergency department.
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Master Thesis
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Submitted on : Tuesday, September 8, 2020 - 3:38:49 PM
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Rudy Drillon. Enquête de pratiques professionnelles auprès des médecins exerçants aux urgences de Nouvelle Aquitaine au sujet des techniques de réduction de la pronation douloureuse de l’enfant. Médecine humaine et pathologie. 2020. ⟨dumas-02933577⟩

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