Treatment of first-time traumatic anterior shoulder dislocation UK.TASH-D Study

Rees JL, Shah A, Edwards K, Sanchez-Santos MT, Robinson DE, Delmestri A, Carr A, Arden N, Lamb S E, Rangan A, Judge A, Pinedo-Villanueva R, Holt T, Hopewell S, Prieto-Alhambra D, Collins G
Record ID 32016000204
Authors' objectives: Traumatic anterior shoulder dislocation (TASD) is when the humeral head (top end of the arm bone at the shoulder) is forced out of the shoulder socket frontwards. This can happen after sport injuries or falls and is most common in younger patients. The injury is very painful and the shoulder often stays dislocated until it is reduced or put back in hospital. This type of injury often causes the joint to remain unstable and more dislocations can occur. In some people these dislocations are very frequent and can even occur during sleep. The two main ways of treating this problem are physiotherapy and surgery. Traditionally physiotherapy has been used first and surgery used if the physio does not work. However, in recent years patients are more frequently being treated with surgery as the risk or further dislocation without surgery is considered to be high. While surgical treatment has become more common, researchers and doctors still don t know which patients are best treated with physiotherapy and which patients are best treated first with surgery. Because dislocations cause so much pain, stress and disability, it is important to know if surgery after one dislocation is worthwhile in preventing further problems. Rather than run a clinical trial involving patients, we have an opportunity to answer this question using information that is already available within the NHS. GP s record all patient problems on a computerised system called CPRD. We know there are around 26,534 patients with shoulder dislocations in the database, and at least 10,449 of these will be young patients aged 16-35 years [7] with TASD. This large number of shoulder dislocation records means we can answer this commissioned research question using analysis of this database. We will also need to use a Hospital database that contains information on the patients that have had operations. This hospital database is called HES and it records the type of operations that patients have had such as shoulder surgery for dislocations. We therefore plan a study to link these two large computer record systems to see which patients had surgery and which did not and to assess which patients had further dislocations. To do this we have put together a research team with expertise in shoulder dislocation and expertise in studying these two databases. The team has used this method of database analysis before including the advanced statistical methods that need to be used. To further ensure this database can be successfully used for this purpose, we plan to first test the coding of shoulder dislocations in the CPRD database by performing an initial validation (or testing) study for 9 months. If this is successful it means we have a high chance of then answering the research question with a full analysis of the linked CPRD and HES databases which will take another 18 months. During this anlaysis we will also identify any predictors of re-dislocation such as occupation or sport that may influence the need for surgery. On completion of this study we plan to publicise our results widely and use the evidence to influence and improve patient pathways and guidelines for primary care and hospital health workers who manage and treat patients with first time traumatic anterior shoulder dislocation.
Project Status: Completed
Year Published: 2019
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Shoulder Injuries
  • Shoulder Dislocation
  • Shoulder Joint
  • Athletic Injuries
  • Arthroscopy
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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