The utility of routine x-rays in all glass-caused wounds

It is a common practice to routinely obtain x-rays before clinical evaluation and cleaning of glass-caused wounds to assess for possible retained foreign bodies (FBs). [Am J Surg 1982;144(July):63-5; Ann Emerg Med 1983;12(July):434-7; Emerg Med Clin NorthAm 1985;3(2):383-91; Emerg Med Clin North Am 1992;10:163-77; Ann Emerg Med 1988 17(12):125-34; Emerg Med Clin North Am 1992;10(4):757-79] This prospective study was designed to question whether routine x-rays are necessary for all patients with glass-caused wounds. Plain films were taken before clinical exam but not reviewed until after the exam was completed. Wounds were categorized according to depth, whether or not the clinician was able to adequately explore the wound, and whether or not an FB was found clinically. Glass FBs were found in 23 (8.7%) of 264 wounds. Approximately half of the wounds were no deeper than subcutaneous fat. Almost all of these superficial wounds (99.2%, 133/134) could be adequately explored. There were clinically undetected FBs (ie, wounds that benefited from x-ray) in 2 (1.5%) of 134 superficial wounds and 10 (7.7%) of 130 deeper wounds. In light of the benign nature of the 2 superficial wounds in which an FB was missed clinically, we conclude that there exists a subset of glass-caused wounds that are superficial and adequately explorable, and, therefore, do not need routine x-rays.