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Selective radiography in 100 patients with suspected shoulder dislocation
Gregory W Hendey1, M Kristin Chally, V Brooks Stewart
1Department of Emergency Medicine, University of California San Francisco-Fresno, University Medical Center, Fresno, California 93702, USA.
The Journal of Emergency Medicine
|June 27, 2006
Summary
A validated algorithm for selective radiography in emergency departments significantly reduced shoulder X-ray use and patient wait times. This approach safely managed suspected shoulder dislocations without missing fractures or dislocations.
Area of Science:
- Emergency Medicine
- Radiography
- Orthopedics
Background:
- Shoulder dislocations are common in emergency departments.
- Radiographs are frequently used for diagnosis and management.
- Overutilization of radiography increases costs and patient exposure.
Purpose of the Study:
- To prospectively validate a clinical decision algorithm for selective radiography in suspected shoulder dislocations.
- To assess the impact of the algorithm on X-ray utilization and emergency department (ED) times.
- To evaluate the safety of the algorithm in detecting fractures and persistent dislocations.
Main Methods:
- A prospective study involving 100 patients with suspected shoulder dislocation.
- Physicians used a validated algorithm incorporating mechanism of injury, prior dislocations, and clinical certainty to guide radiography.
- Follow-up included telephone calls and comprehensive chart review.
Main Results:
- An overall 46% reduction in X-ray utilization was achieved.
- Mean ED times were significantly shorter for patients managed without radiographs.
- No missed fractures or persistent dislocations were identified during follow-up.
Conclusions:
- Selective radiography using a clinical decision rule is effective in reducing X-ray use and ED wait times for shoulder dislocations.
- The validated algorithm safely identifies patients who do not require radiographs, minimizing unnecessary radiation exposure.
- This approach enhances efficiency in the emergency department setting without compromising patient safety.