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.
- fractures, bone
- diagnostic imaging
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Contributors LMR and MM conceived and designed the study. LMR supervised the conduct of the study and data collection. CWM, BLK and DS undertook recruitment of participating centers and patients and managed the data, including quality control. LMR and CWM provided statistical advice on study design and analyzed the data. CWM drafted the manuscript, and all authors contributed substantially to its revision. LMR and CWM take responsibility for the paper as a whole.
Funding The authors have not declared a specific grant for this research fromany funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval Johns Hopkins Hospital Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Presented at This work was presented at the AAP National Conference and Exhibition in Chicago, IL, in 2017.
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