Repeat Radiographic Imaging in Patients with Long Bone Fractures Transferred to a Pediatric Trauma Center

Abstract

This study sought to determine the proportion of children with long bone fractures who undergo duplicate radiographic imaging after transfer to a pediatric trauma center (PTC) for further management. The secondary objective was to explore provider rationale and diagnostic yield of repeat X-rays. This was a single-site, retrospective cohort study conducted at a PTC. All patients, aged 0–21 years, who were transferred to the PTC for management of a long bone fracture were included. Electronic medical records were reviewed to determine the proportion of children who had repeat radiographic imaging and the provider rationale for obtaining this. T-test and Χ2 analyses were used to compare patients who had repeat X-rays with those who did not. During the study period, 309 patients (63% male, mean age 7.2±4.3 years) were transferred from 30 referring hospitals. Of these, 43% (n=133) underwent repeat radiographs. Patient age (p=0.9), gender (p=0.7), fracture location (p=0.19), and type of referring emergency department (pediatric vs general, p=0.3) were not significantly associated with repeat imaging. Rationale for repeat imaging could be ascertained in 31% of cases (n=41); the most common reasons were request by orthopedist (17%, n=23) and suboptimal original imaging (10%, n=13). Repeat imaging at the PTC did not reveal new or additional diagnoses in any case. Nearly half of the children in our study population undergo repeat and likely unnecessary imaging. Strategies to reduce repeat radiographs should be developed, as redundant imaging exposes patients to additional radiation and increases medical expense.

Effect of a Protocol to Reduce Radiographic Imaging in Pediatric Patients With Suspected Fractures

“…Prior literature had emphasized the need for strategies to reduce repeat images in evaluation of pediatric fractures. One retrospective cohort study revealed that 43% of patients who transferred from a referring hospital underwent repeat radiographs, and none of those repeat radiographs provided new or additional diagnoses 15. Therefore, the reduction in repeat imaging at our institution was an extremely promising result, particularly given that there was no evidence to suggest that the additional radiographic images at our institution had greater clinical value than x-rays from external locations.…”

Visualizing the Invisible: Invisible Waste in Diagnostic Imaging

“…While it was predicted that retakes would drastically reduce when digital images replaced films (due to improved image production), this has not occurred [ 29 , 30 ]. Retakes and rejects are reported to be at the same level (5–12%) now as when films were used [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

From bone to nanoparticles: development of a novel generation of bone derived nanoparticles for image guided orthopedic regeneration

“…Radiographic imaging, such as plain X-ray, Computed Tomography (CT), and Dual Energy X-ray Absorptiometry (DEXA), are the most common methods for clinical bone diag-nosis, but many studies find that radiography alone offers an incomplete assessment of bone healing and is unreliable in determining the healing stages of bone. [50][51][52] Other drawbacks of radiographic imaging include frequent radiation exposure and high cost, which can be especially detrimental for children, pregnant women, and immune-compromised or ill patients. Recent efforts have focused on developing imageguided therapies that can monitor the host-material interaction of implants, quantitatively assess bone healing, and evaluate the performance of drugs or grafts in a real-time, non-invasive, highly sensitive, and cost-effective way.…”