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

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.