Repeat radiographic imaging in patients with long bone fractures transferred to a pediatric trauma center

Courtney W. Mangus, Bruce Klein, Marlene Miller, Fray Dylan Stewart, Leticia Manning Ryan

Research output: Contribution to journalArticle

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 2 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.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
DOIs
StateAccepted/In press - Jan 1 2018

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Pediatrics
Trauma Centers
Bone Fractures
Bone
Imaging techniques
X-Rays
Electronic Health Records
Hospital Emergency Service
Electronic medical equipment
Cohort Studies
X rays
Retrospective Studies
Radiation
Population

Keywords

  • diagnostic imaging
  • fractures, bone

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Repeat radiographic imaging in patients with long bone fractures transferred to a pediatric trauma center. / Mangus, Courtney W.; Klein, Bruce; Miller, Marlene; Stewart, Fray Dylan; Ryan, Leticia Manning.

In: Journal of Investigative Medicine, 01.01.2018.

Research output: Contribution to journalArticle

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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 2 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.",
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