Streamlining emergent hand and wrist radiography with a modified four-view protocol

Area of Science:

• Radiology
• Orthopedic Imaging

Background:

• Traditional seven-view radiographic studies are standard for evaluating acute hand and wrist fractures.
• Assessing the diagnostic efficacy of reduced radiographic protocols is crucial for improving efficiency and patient throughput.

Purpose of the Study:

• To compare the diagnostic performance of a modified four-view hand and wrist radiographic series against the traditional seven-view protocol for acute fractures.

Main Methods:

• A retrospective analysis of 240 patients with acute hand and wrist trauma was conducted.
• Radiographs were initially interpreted in a seven-view set, then reformatted into a four-view set (three hand views, one wrist view) for reinterpretation by the same radiologists after an 8-week delay.
• Inter-observer and inter-method agreement were assessed using Kappa statistics, with generalized linear mixed model analysis for diagnostic comparison.

Main Results:

• The four-view protocol identified 126 (26.2%) acute osseous findings, compared to 142 (29.6%) with the seven-view protocol.
• Average inter-observer agreement was high for both protocols (0.7845 for seven-view, 0.8261 for four-view).
• Inter-method agreement was also strong (0.823), with no statistically significant difference in injury diagnosis odds ratio (0.69, P=0.0873) between the two methods.

Conclusions:

• The modified four-view hand and wrist radiographic series demonstrates comparable diagnostic accuracy to the traditional seven-view protocol for acute fracture evaluation.
• This suggests a potential for a more efficient imaging protocol without compromising diagnostic outcomes.