358 What Is the Caregiver Experience of Soft-Cast Removal at Home Following Paediatric Upper Limb Trauma? a Qualitative Analysis

Aim

At-home soft-cast removal has shown to be safe and effective following paediatric orthopaedic trauma. It minimises clinician contact time, reducing costs for hospitals and families. Limited qualitative evidence on caregiver experience exists. This study explores the caregiver experience of at-home soft-cast removal.

Method

Retrospective analysis of fractures (<16yrs) requiring application of circumferential soft-cast, later removed at home, between July–August 2022. Demographic data collected included age, fracture type and angulation, need for manipulation and complications or unplanned re-attendance.

A caregiver telephone Likert questionnaire, friends and family satisfaction score and qualitative descriptors were used to assess the caregiver experience.

Results

30 families were contacted at mean 110 days post-injury. Mean age 8 years. 25 successfully removed their soft cast at home with no further orthopaedic follow-up. 36% distal radius and 36% both-bone forearm. 64% of injuries required manipulation under procedural sedation with mean fracture angulation 26 degrees. Two patients re-attended due to parental concern regarding the appearance of the limb after soft-cast removal. 64% of families were ‘extremely’ or ‘somewhat’ satisfied, and 56% were ‘extremely’ or ‘somewhat’ likely to recommend at-home soft-cast removal. Qualitative descriptors indicated a range of experiences, from ‘easy’ and ‘convenient’, to ‘difficult’ and ‘traumatic’.

Conclusions

Our tertiary centre experience confirms that at-home soft-cast removal with no further orthopaedic follow-up is safe and feasible, even after displaced upper limb fractures requiring manipulation under sedation. The majority of families report at-home soft-cast removal to be a positive experience, however this is not universal. Developing patient information resources is likely to improve caregivers’ experiences.