A protocol for selecting patients with injured extremities who need x-rays

Area of Science:

• Radiology
• Medical Imaging
• Healthcare Management

Background:

• Excessive radiography contributes to healthcare costs and radiation exposure.
• Developing protocols for appropriate imaging selection is crucial for cost containment and patient safety.

Purpose of the Study:

• To develop and prospectively test a protocol for selecting patients with injured extremities who require x-ray examination.
• To determine the safety and effectiveness of the protocol in reducing unnecessary radiography.

Main Methods:

• A protocol was developed for selecting patients with injured extremities for x-ray examination.
• The protocol was prospectively tested in 848 patients.
• X-ray usage, missed fractures, treatment appropriateness, and patient outcomes were assessed.

Main Results:

• Strict adherence to the protocol could have reduced x-ray usage by 12% for upper extremities and 19% for lower extremities.
• Actual reductions were 5% and 16%, limited by patient demand.
• One fracture in 287 was missed, with appropriate treatment and satisfactory outcomes.
• The protocol could save $79 million to $139 million nationwide by eliminating superfluous x-ray procedures.

Conclusions:

• The developed protocol is a safe and effective tool for judicious radiography selection in injured extremities.
• Patient demand can limit the effectiveness of protocols aimed at reducing x-ray usage.
• Cost-containment strategies for radiography should balance savings with maintaining a safe threshold for essential imaging.