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Published on: September 11, 2011
Overutilization of Radiographs for Pulled Elbow Among Orthopedic Surgeons Compared With Pediatricians
Assaf Kadar1, Noga Yaniv2, Yaniv Warschawski3
1From the Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.
Insights
Orthopedic surgeons frequently order elbow radiographs for pediatric patients more than pediatricians do. Reducing imaging rates for this population is recommended to optimize care.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Public Health
Background:
- Pulled elbow injuries are common in young children.
- Variations in diagnostic imaging practices exist among different medical specialties.
Purpose of the Study:
- To analyze the utilization of elbow radiographs in pediatric pulled elbow cases.
- To investigate the association between physician specialty, patient demographics, and socioeconomic status with imaging practices.
Main Methods:
- Retrospective review of electronic medical records from a large Israeli health provider (2005-2020).
- Inclusion of patients aged 4.5 months to 7 years diagnosed with pulled elbow.
- Data collected included physician specialty and radiographic imaging acquisition.
Main Results:
- 4357 pediatric patients were analyzed; 62.8% were girls.
- Pediatricians treated 51.5% of cases, while orthopedic surgeons treated 19.9%.
- Elbow radiographs were obtained for 13.1% of patients, with orthopedic surgeons requesting most (36.5%). Socioeconomic status influenced access to specialized care.
Conclusions:
- Orthopedic surgeons utilize elbow radiographs significantly more than pediatricians for pulled elbow injuries.
- Strategies should be developed to reduce the rate of radiographic imaging in this pediatric population.
Methods:
Electronic medical records of the largest health provider in Israel, which provides health services to more than 50% of the population, were reviewed for pulled elbow cases between 2005 and 2020. Patients aged 4.5 months to 7 years were included. Demographic information, the discipline of the treating physician, and acquisition of elbow radiographs were gathered.
Results:
A total of 4357 patients, 62.8% girls, were included. The average body mass index was 16.1 (SD, 1.2). Most patients were from communities in the upper half of the socioeconomic status clusters 6 to 10 (64.63%). Most patients were attended by a pediatrician (51.5%), followed by an orthopedic surgeon (19.9%). Radiographs were acquired for 570 children (13.1%). Most radiographs (36.5%) were requested by orthopedic surgeons and for children in the boundary age groups. The patient's socioeconomic status was associated with access to physicians of different subspecialties, and lower income families had a higher tendency to be treated by nonspecialized physician ( P < 0.001).
Conclusions:
Orthopedic surgeons use elbow radiographs much more than pediatricians; effort should aim at reducing the imaging rate for this population.
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