Radiographic imaging use for lacerations: A necessity or over-imaging?

Lacerations are a common cause for individuals seeking care in Emergency Departments. Radiographs are commonly the first imaging modality used when foreign bodies (FBs) or fractures are suspected. However, the effectiveness of radiographs for assessing different laceration presentations remains unexplored, with no standardised practices or guidelines available. This paper aims to investigate the diagnostic yield of radiographic imaging for different laceration presentations.

A retrospective cross-sectional study design was employed to analyse data of patients who presented for radiographs where lacerations have been mentioned in the referral. Data was collected from two hospitals over a 12-month period. Key variables collected included anatomical region, mechanism of injury, clinical question, and imaging findings. Pearson's Chi-Square test was to assess the distribution of imaging outcomes.

In total, 10 % (n = 90/869) of radiographs performed for lacerations showed a positive or new abnormal finding, and 7 % (n = 61/869) of radiographs showed suspicious or inconclusive findings. Radiographs were commonly used to assess for fractures and FBs, which were found in 7 % (n = 59/869) and 3 % (n = 28/869) of patients, respectively. However, there were more inconclusive or suspected findings of FBs than confirmed cases. Request forms with no clear mechanism of injury (n = 316) had the lowest proportion of clinically significant findings.

Radiographs have a relatively low diagnostic yield for lacerations, suggesting the need for sufficient physical examination prior to imaging and alignment between clinical judgment and imaging necessity.

The findings highlight the need for a cautious approach in radiographic utilisation, acknowledging its effectiveness in detecting fractures in injury presentations while understanding its limitations in foreign body detection.