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Enhancing X-Ray Orders by Utilizing Proper Physical Examination and Applying Clinical Guidelines.

Samuel K Gerak1,2, Charles T Mehlman2

  • 1Department of Orthopaedic Surgery, University of Cincinnati Medical Center.

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PubMed
Summary

Many pediatric patients receive unnecessary radiographs due to bypassed clinical judgment. Returning to physical exams and clinical guidelines like Ottawa Knee Rules (OKR) and Ottawa Ankle Rules (OAR) is recommended.

Keywords:
Ottawaadjacent imagingclinical guidelinesimagingphysical examinationradiographscreeningx-ray

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Area of Science:

  • Pediatric imaging
  • Radiography utilization
  • Clinical decision-making

Background:

  • Pediatric extremity injuries often require only one radiograph.
  • Healthcare costs and radiation exposure necessitate judicious radiograph ordering.
  • Clinical guidelines like Ottawa Ankle Rules (OAR) and Ottawa Knee Rules (OKR) exist but are often overlooked.

Purpose of the Study:

  • To review the radiographic practices of healthcare providers in pediatric extremity injuries.
  • To assess adherence to clinical guidelines in ordering radiographs for children.
  • To identify factors influencing the decision to order radiographs.

Main Methods:

  • Retrospective cohort study of 179 pediatric patients with extremity injuries.
  • Detailed chart review including demographics, history, physical exam, radiographs, and follow-up.
  • Analysis focused on the relationship between physical examination findings and radiograph orders, specifically for knee, ankle, and foot complaints, in relation to OAR and OKR.

Main Results:

  • Unnecessary radiographs were performed in 86.3% of patients with documented physical exams.
  • Younger age was significantly associated with unnecessary knee and foot radiographs, negative radiographs, and zero indicated radiographs.
  • Older age correlated with an increased number of unnecessary radiographs ordered.
  • Provider type and triage location did not significantly impact outcomes.

Conclusions:

  • A significant proportion of pediatric patients undergo radiography without proper screening.
  • Providers should re-emphasize physical examinations and utilize clinical guidelines like OAR and OKR.
  • Provider age may influence radiographic ordering habits, necessitating awareness and potential intervention.