Effect of a Protocol to Reduce Radiographic Imaging in Pediatric Patients With Suspected Fractures

Area of Science:

• Pediatric Radiology
• Diagnostic Imaging
• Evidence-Based Medicine

Background:

• Conventional evaluation of pediatric fractures involves multiple x-rays, increasing patient discomfort and radiation exposure.
• This standard approach may not always provide additional clinical benefit.

Purpose of the Study:

• To assess if a simplified radiographic protocol can reduce the number of x-rays for suspected pediatric fractures.
• To determine if this protocol impacts diagnostic accuracy and patient outcomes.

Main Methods:

• A retrospective comparative study was conducted at two sites (urgent care and emergency department) within an academic medical center.
• A simplified radiographic protocol was developed based on initial chart reviews of 495 patients.
• The protocol was implemented, and outcomes were compared with a subsequent cohort of 333 patients.

Main Results:

• The implemented protocol significantly reduced the average number of x-ray views per patient from 5.1 to 3.4 (P <0.001).
• Imaging of multiple anatomic areas decreased, particularly for elbow injuries (9% vs. 44%, P <0.001).
• No difference was observed in missed injuries or return visits to radiology; however, fewer patients with outside imaging required additional x-rays.

Conclusions:

• A simplified radiographic protocol effectively reduces x-ray utilization in pediatric fracture evaluations.
• This protocol is safe and does not compromise the detection of fractures in children.
• The findings support the adoption of focused radiographic protocols to optimize pediatric imaging practices.