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. 2023 Jan 1;43(1):61-64.
doi: 10.1097/BPO.0000000000002262. Epub 2022 Sep 12.

Effect of a Protocol to Reduce Radiographic Imaging in Pediatric Patients With Suspected Fractures

Jamie A Schlacter  1 , Demetrios Roussos  2 , Karim Masrouha  2 , Mara Karamitopoulos  2 , Cordelia Carter  2 , Andrew Price  2 , Pablo Castañeda  2 , Jody Litrenta  2
Affiliations

Effect of a Protocol to Reduce Radiographic Imaging in Pediatric Patients With Suspected Fractures

Jamie A Schlacter et al. J Pediatr Orthop. .

Abstract

Background: Children with suspected fractures are typically evaluated with multiple x-rays. This approach can add time, discomfort, and radiation exposure without clinical benefit. The purpose of this study was to determine whether a focused radiographic protocol could reduce the number of x-rays performed without missing any fractures.

Methods: Pediatric patients presenting at 2 sites within an academic medical center [urgent care (UC) and the emergency department(ED)] for a suspected fracture were identified. There were 495 patients (UC, 409; ED, 86) over a 3-month period. A retrospective chart review was performed to characterize the standard x-rays performed. Using this data, a simplified protocol was developed and distributed. Subsequently, 333 patients (UC, 259; ED, 74) were evaluated over the same period 1-year later. The main outcome measures included the final diagnosis, the total number of x-rays, the number of anatomic areas imaged, visit length, and the time for additional trips to radiology. Charts were reviewed to identify any missed injuries. Welch 2-sample t tests and Fisher exact tests were used for statistical analysis.

Results: After implementing the radiographic protocol, there was a significant reduction in the number of x-ray views, 3.4 versus 5.1 ( P <0.001). There was a decrease in imaging of multiple anatomic areas with the largest reduction occurring in patients presenting with elbow injuries (9% vs. 44%, P <0.001). No difference was found in the rate of patients sent back to radiology (6% vs. 7%, P =0.67). However, among patients presenting with outside imaging, significantly fewer were sent to radiology for additional x-rays (29% vs. 50%, P <0.01).

Conclusion: A simple radiographic protocol for evaluating pediatric patients with suspected fractures safely led to a decrease in the overall number of x-rays without missing any injuries.

Level of evidence: Level III, retrospective comparative study.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Beaty JH, Kumar A. Fractures about the knee in children. J Bone Joint Surg Am. 1994;76:1870–1880.
    1. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6:146–156.
    1. Boutis K, Von Keyserlingk C, Willan A, et al. Cost consequence analysis of implementing the low risk ankle rule in emergency departments. Ann Emerg Med. 2015;66:455–463.e4.
    1. Brown Z, Perry M, Wozniak AW, et al. Decreasing radiation exposure in pediatric clavicle and metatarsal fractures: a QI initiative. J Pediatr Orthop. 2021;41:177–181.
    1. Genadry KC, Monuteaux MC, Neuman MI, et al. Management and outcomes of children with Nursemaid’s elbow. Ann Emerg Med. 2021;77:154–162.