Nursing radiation-protection compliance and 30-day wound and pin-site adverse events after supracondylar humerus fracture fixation in children

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Abstract

BACKGROUND: Fluoroscopy is integral to operative fixation of supracondylar humerus fractures in children, but case-level nursing radiation-protection compliance (NRPC) has not been well characterised as a potential marker of broader perioperative process quality. We examined the association between NRPC and early wound- and pin-site-related outcomes. METHODS: We conducted a single-centre retrospective cohort study of children aged <14 years who underwent fluoroscopy-assisted operative fixation for supracondylar humerus fractures at The Second Affiliated Hospital of Wenzhou Medical University, China, between 2018 and 2023. NRPC was assessed using three binary components reflecting recent formal radiation-protection training, absence of radiation-protection-related quality-control deductions, and documented implementation of radiation-protection measures during the index procedure. Components were summed to a 0-3 score and categorised as Low (0-1) or High (2-3) NRPC. The primary outcome was any wound- or pin-site-related adverse event within 30 days. The primary multivariable logistic regression model adjusted for calendar year, Gartland classification, operative duration, and emergency surgical status. Firth penalized regression, ordinal-score analyses, and separate nurse- and surgeon-clustered mixed-effects models were performed as sensitivity analyses. RESULTS: Of 360 children identified, 256 children met the eligibility criteria and had ascertainable NRPC and primary-outcome data; 164 (64%) were classified as High NRPC and 92 (36%) as Low NRPC. Overall, 37/256 children (14.5%) experienced the primary outcome. The observed event rate was 11.0% (18/164) in the High NRPC group and 20.7% (19/92) in the Low NRPC group, corresponding to a crude OR of 2.11 (95% CI 1.04-4.27; p = 0.037) for Low versus High NRPC. In the primary adjusted model, the association was attenuated and imprecise (adjusted OR 1.70, 95% CI 0.80-3.57; p = 0.165). Firth penalized regression yielded OR 1.67 (95% CI 0.80-3.49; p = 0.168), while separate mixed-effects models yielded OR 1.65 (95% CI 0.76-3.58; p = 0.205) for nurse clustering and OR 1.68 (95% CI 0.77-3.66; p = 0.190) for surgeon clustering. Per 1-point increase in the NRPC score, the adjusted OR was 0.70 (95% CI 0.48-1.02; p = 0.061). CONCLUSION: Higher NRPC was associated with lower unadjusted rates of 30-day wound- and pin-site-related adverse events, but the association was attenuated and statistically imprecise after temporal and clinical adjustment. Similar directional estimates across sensitivity analyses support NRPC as an exploratory marker of broader perioperative process quality rather than as an independently established predictor or causal determinant of wound outcomes.

Abstract as published, via PubMed.