{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:32:05Z","timestamp":1792794725279,"version":"4.5.0"},"reference-count":41,"publisher":"National Institute for Health and Care Research","issue":"18","license":[{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["14\/160\/01"],"award-info":[{"award-number":["14\/160\/01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"Background<\/jats:title>Shoulder dislocations are the most common joint dislocations seen in emergency departments. Most traumatic cases are anterior and cause recurrent dislocations. Management options include surgical and conservative treatments. There is a lack of evidence about which method is most effective after the first traumatic anterior shoulder dislocation (TASD).<\/jats:p><\/jats:sec>Objectives<\/jats:title>To produce UK age- and sex-specific incidence rates for TASD. To assess whether or not surgery within 6 months of a first-time TASD decreases re-dislocation rates compared with no surgery. To identify clinical predictors of recurrent dislocation.<\/jats:p><\/jats:sec>Design<\/jats:title>A population-based cohort study of first-time TASD patients in the UK. An initial validation study and subsequent propensity-score-matched analysis to compare re-dislocation rates between surgery and no surgery after a first-time TASD. Prediction modelling was used to identify potential predictors of recurrent dislocation.<\/jats:p><\/jats:sec>Setting<\/jats:title>UK primary and secondary care data.<\/jats:p><\/jats:sec>Participants<\/jats:title>Patients with a first-time TASD between 1997 and 2015.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Stabilisation surgery within 6 months of a first-time TASD (compared with no surgery). Stabilisation surgery within 12 months of a first-time TASD was also carried out as a sensitivity analysis.<\/jats:p><\/jats:sec>Main outcome measure<\/jats:title>Re-dislocation rate up to 2 years after the first TASD.<\/jats:p><\/jats:sec>Methods<\/jats:title>Eligible patients were identified from the Clinical Practice Research Datalink (CPRD) (1997\u20132015). Accuracy of shoulder dislocation coding was internally validated using the CPRD General Practitioner questionnaire service. UK age- and sex-specific incidence rates for TASD were externally validated against rates from the USA and Canada. A propensity-score-matched analysis using linked CPRD and Hospital Episode Statistics (HES) data compared re-dislocation rates for patients aged 16\u201335 years, comparing surgery with no surgery. Multivariable Cox regression models for predicting re-dislocation were developed for the surgical and non-surgical cohorts.<\/jats:p><\/jats:sec>Results<\/jats:title>Shoulder dislocation was coded correctly for 89% of cases in the CPRD [95% confidence interval (CI) 83% to 95%], with a \u2018primary\u2019 dislocation confirmed for 76% of cases (95% CI 67% to 85%). Far fewer patients than expected received stabilisation surgery within 6 months of a first TASD, leading to an underpowered study. Around 20% of re-dislocation rates were observed for both surgical and non-surgical patients. The sensitivity analysis at 12 months also showed little difference in re-dislocation rates. Missing data on risk factors limited the value of the prediction modelling; however, younger age, epilepsy and sex (male) were identified as statistically significant predictors of re-dislocation.<\/jats:p><\/jats:sec>Limitations<\/jats:title>Far fewer than the expected number of patients had surgery after a first-time TASD, resulting in an underpowered study. This and residual confounding from missing risk factors mean that it is not possible to draw valid conclusions.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>This study provides, for the first time, UK data on the age- and sex-specific incidence rates for TASD. Most TASD occurs in men, but an unexpected increased incidence was observed in women aged >\u200950 years. Surgery after a first-time TASD is uncommon in the NHS. Re-dislocation rates for patients receiving surgery after their first TASD are higher than previously expected; however, important residual confounding risk factors were not recorded in NHS primary and secondary care databases, thus preventing useful recommendations.<\/jats:p><\/jats:sec>Future work<\/jats:title>The high incidence of TASD justifies investigation into preventative measures for young men participating in contact sports, as well as investigating the risk factors in women aged >\u200950 years. A randomised controlled trial would account for key confounders missing from CPRD and HES data. A national TASD registry would allow for a more relevant data capture for this patient group.<\/jats:p><\/jats:sec>Study registration<\/jats:title>Independent Scientific Advisory Committee (ISAC) for the Medicines and Healthcare Products Regulatory Agency (ISAC protocol 15_0260).<\/jats:p><\/jats:sec>Funding<\/jats:title>The National Institute for Health Research Health Technology Assessment programme.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta23180","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T14:04:14Z","timestamp":1556719454000},"page":"1-104","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Treatment of first-time traumatic anterior shoulder dislocation: the UK TASH-D cohort study"],"prefix":"10.3310","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1818-5800","authenticated-orcid":true,"given":"Jonathan 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