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The Adequacy of Emergency Room (ER) and Urgent Care Center (UCC) Radiographs for Pediatric Orthopaedic Injuries
Eric Margulies, BS1, Alexandria L Case, BSE1, Karan Dua, M.D.2, Nathan N O'Hara, MHA1 and Joshua M Abzug, MD1, (1)University of Maryland School of Medicine, Baltimore, MD, (2)Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD

Introduction Emergency room (ER) and urgent care center (UCC) providers are often the first evaluators of acute pediatric orthopedic injuries, including obtaining radiographs. After initial evaluation, these patients are commonly referred to orthopaedic surgeons for further evaluation, who sometimes need to obtain additional radiographs that may increase the length of the visit, healthcare costs, and radiation exposure to the patient. The purpose of this study was to determine the adequacy of the initial radiographs obtained by ER and UCC providers.
Materials & Methods A prospective study was performed of patients who presented to the pediatric orthopedic office for injury evaluation after being seen at an outside ER/UCC, during which radiographs were obtained. The adequacy of the initial radiographs was determined in a binary fashion with images deemed 'adequate' if no additional radiographs were obtained and considered 'inadequate' if the physician ordered new radiographs. Patients who had additional radiographs to assess a potential loss of reduction were excluded. The duration of the orthopaedic office visit was recorded for all patients.
Results The average number of radiographs obtained by an ER/UCC was 2.9 (SD=0.87). 53% of ER/UCC radiographs were deemed adequate and 47% were considered inadequate. Patients with inadequate radiographs required an average of 3.4 (95% CI: 2.7-4.0) additional images. The most common reasons for repeat radiographs were missing views (33.3%), an inadequate lateral view (29.2%), and poor image quality (16.7%). Patients with adequate images had a significantly shorter clinic visit time (p <0.001) compared to patients with inadequate radiographs, with a mean difference of 32.0 minutes (95% CI: 22.4-41.6).
Conclusions ER/UCC diagnostic imaging is often insufficient to permit the adequate diagnosis and treatment by pediatric orthopaedic surgeons. ER/UCC providers would benefit from better education regarding how to optimize the radiographs obtained during acute pediatric orthopaedic injury evaluations.


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