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Reconsider Indications for X-Ray in Pediatric Trauma

Different standard radiographs reveal a low fracture rate among children with traumatic injuries.

Alternate procedures over radiographs may be appropriate in many pediatric trauma patients to rule out fractures or dislocations, according to a study published in Emergency Radiology.

Researchers from Germany performed a transversal cohort study to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center.

The researchers used a sample size of 200 images of each standard radiograph for patients younger than 18.

The most common examinations and fracture rates:

Fracture rateExamination
70.5%Clavicle
54.5%Forearm
53%Wrist
41.5%Elbow
30.5%Lower leg
20%Hand
18.5%Finger
12.5%Toe
12%Forefoot
11.5%Ankle
9%Shoulder
6.5%Patella
5.5%Foot
4%Knee
2%Conventional rib series
1.5%Lumbar spine
1%Towne view
0.5%Skull
0%Cervical spine
0%Odontoid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Differences were found in the mean age of analyzed pediatric trauma patients in correlation to different standard radiographs.

The researchers concluded that their study findings showed a relevant amount of different standard radiographs revealed a low fracture rate. “Therefore, indications for X-ray should be checked properly and alternative procedures should be discussed with the patient and the parents,” they wrote. “Clinical decision rules should be developed and pathways have to be implemented to minimize radiation exposure, waiting time, and costs.”