Safely Reducing Unnecessary Radiographs in Suspected Pediatric Musculoskeletal Injuries

作者：Sarah Lander, Sarah Obudzinski, Julie Michels, Anne Brayer, Taylor D’Amore, Mitchel Chess, Christopher Cook, Derek Wakeman, James O. Sanders · 发表于：Pediatric Emergency Care · 年份：2023 · DOI：10.1097/pec.0000000000003004 · 被引用次数：5 · 研究领域：Radiation Dose and Imaging、Bone fractures and treatments、Musculoskeletal Disorders and Rehabilitation

BACKGROUND: While radiographs are a critical component of diagnosing musculoskeletal (MSK) injuries, they are associated with radiation exposure, patient discomfort, and financial costs. Our study initiative was to develop a system to diagnose pediatric MSK injuries efficiently while minimizing unnecessary radiographs. METHODS: This was a quality improvement trial performed prospectively at a single level one trauma center. A multidisciplinary team with leaders from pediatric orthopedics, trauma surgery, emergency medicine, and radiology created an algorithm delineating which x-rays should be obtained for pediatric patients presenting with MSK injuries. The intervention was performed in the following 3 stages: stage 1: retrospective validation of the algorithm, stage 2: implementation of the algorithm, and stage 3: sustainability evaluation. Outcomes measured included number of extra radiographs per pediatric patient and any missed injuries. RESULTS: In stage 1, 295 patients presented to the pediatric emergency department with MSK injuries. A total of 2148 radiographs were obtained, with 801 not indicated per the protocol, for an average of 2.75 unnecessary radiographs per patient. No injuries would have been missed using the protocol. In stage 2, 472 patients had 2393 radiographs with 339 not indicated per protocol, averaging 0.72 unnecessary radiographs per patient, a significant reduction from stage 1 ( P < 0.001). There were no missed injuries identified on follow-up. In ...