Predicting the result of our X-rays, a way to identify overuse? the Ulster Hospital Dundonald

The objectives of the study were to identify areas of the unnecessary use of diagnostic plain X-rays in the emergency department. Requests for inappropriate plain X-ray investigations have resource, radiation and overcrowding implications for the emergency department.

The junior doctor or nurse practitioner treating patients attending the emergency department requiring X-ray completed a proforma prospectively. Questions included the type of X-ray, predicted result of the X-ray and observed result of X-ray.

A total of 226 out of 280 X-rays (81%) were accurately predicted, 94 X-rays (34%) were abnormal. Facial bones (100%) and skull (79%) were most commonly X-rayed when the result was predicted accurately to be normal. The threshold for X-raying abdomen, kidney, ureter and bladder and lumbar spine was low with normal accurate predictions of 67, 75 and 75%, respectively. Normal knee and foot X-rays were predicted accurately in 61 and 60% of cases, respectively, with a yield of 28 and 13%, respectively.

The training of emergency medicine staff should include education about clinical indications from guidelines and recommendations about X-ray use, information on the dose of radiation exposure, implications of resources and overcrowding of departments.