Decreasing Radiation Exposure in Pediatric Clavicle and Metatarsal Fractures: A QI Initiative.

Szczegóły
Abstrakt

Tytuł:: Decreasing Radiation Exposure in Pediatric Clavicle and Metatarsal Fractures: A QI Initiative.
Autorzy:: Brown Z; Loyola University Chicago Stritch School of Medicine, Maywood.
Perry M; Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA.
Wozniak AW; Loyola University Chicago Clinical Research Office Biostatistics Core.
Cappello T; Department of Orthopaedic Surgery, Shriners Hospitals for Children, Chicago, IL.
Źródło:: Journal of pediatric orthopedics [J Pediatr Orthop] 2021 Mar 01; Vol. 41 (3), pp. 177-181.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins
Original Publication: New York Ny : Raven Press
MeSH Terms:: Clavicle/*diagnostic imaging
Foot Injuries/*diagnostic imaging
Fractures, Bone/*diagnostic imaging
Metatarsal Bones/*diagnostic imaging
Radiation Exposure/*prevention & control
Adolescent ; Child ; Child, Preschool ; Clavicle/injuries ; Humans ; Infant ; Quality Improvement ; Radiation Exposure/statistics & numerical data ; Radiography ; Retrospective Studies
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Van Tassel D, Owens B, Pointer L, et al. Incidence of clavicle fractures in sports: analysis of the NEISS Database. Int J Sports Med. 2014;35:83–86.
Rammelt S, Heineck J, Zwipp H. Metatarsal fractures. Injury. 2004;35(suppl 2):SB77–SB86.
Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
van Bosse HJP, Patel RJ, Thacker M, et al. Minimalistic approach to treating wrist torus fractures. J Pediatr Orthop. 2005;25:495–500.
Farbman KS, Vinci RJ, Cranley WR, et al. The role of serial radiographs in the management of pediatric torus fractures. Arch Pediatr Adolesc Med. 1999;153:923–925.
O’Neill BJ, Molloy AP, Curtin W. Conservative management of paediatric clavicle fractures. Int J Pediatr. 2011;2011:172571–172574.
Ling S-NJ, Cleary AJ. Are unnecessary serial radiographs being ordered in children with distal radius buckle fractures? Radiol Res Pract. 2018;2018:1–4.
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Samsamy B. No radiograph in the management of pediatric torus fractures. Arch Pediatr Adolesc Med. 2000;154:750–750.
Calder JDF, Solan M, Gidwani S, et al. Management of paediatric clavicle fractures—is follow-up necessary? An audit of 346 cases. Ann R Coll Surg Engl. 2002;84:331–333.
Baraza N, Wood T. Radiography of clavicle fractures—a review of the literature—do various radiographic views of clavicle fractures affect the management plan? Open J Radiol. 2014;04:235–240.
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Entry Date(s):: Date Created: 20201217 Date Completed: 20210506 Latest Revision: 20210506
Update Code:: 20240105
DOI:: 10.1097/BPO.0000000000001725
PMID:: 33332872
: Czasopismo naukowe

Background: Protecting the pediatric population from unnecessary medical radiation is an important public health initiative. Efforts have been made to reduce radiation exposure in the treatment of pediatric fractures without compromising quality of care. Using a standardized protocol for imaging of pediatric clavicle and metatarsal fractures is a reliable method for reducing pediatric radiation exposure in the management of these fractures.
Methods: In the year 2015, the senior author altered follow-up imaging practices for 2 common pediatric fractures: metatarsal and clavicular. Initial radiographic evaluation included the standard 3 views for metatarsal fractures and 2 views for clavicle fractures. This standard diagnostic procedure remained constant throughout the study. Follow-up x-rays from 2009 to 2014 routinely included 3 views of the foot and 2 views of the clavicle. The protocol was changed and from 2016 to 2019, follow-up x-rays for fractures routinely included 2 views of the foot and 1 view of the clavicle, thereby decreasing the number of x-rays utilized to manage these fractures.
Results: There was a significant reduction in the number of clavicle x-rays (P<0.001) and metatarsal x-rays (P=0.004) taken in follow-up between the time-periods. Median values for metatarsal views decreased by 1, matching the adjustment in protocol. In addition, the vast majority of clavicle fractures (90.80%) were managed with 1 follow-up view in 2016 to 2019 compared with 2 views (72.48%) from 2009 to 2014.
Conclusions: This study achieved a reduction in radiation exposure in pediatric patients with nonoperatively managed clavicle and metatarsal fractures. Improving the quality of care of patients through decreasing the number of x-rays taken protects individuals from adverse side effects, as well as offers various public health benefits in terms of reduction in expenditures.
Level of Evidence: Level III-retrospective comparative study.
Competing Interests: The authors declare no conflicts of interest.
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