Ruling Out Unneeded Ankle X-Rays for Kids
Applying simple rule for low-risk injuries helped ER docs cut use by 22 percent
Monday, August 12, 2013
The research appears in the current issue of the CMAJ (Canadian Medical Association Journal). While X-rays are used to diagnose 85 percent to 95 percent of ankle injuries in children, only 12 percent of X-rays show fractures, according to a journal news release.
"Radiography is unnecessary for most children's ankle injuries, and these high rates of radiography needlessly expose children to radiation and are a questionable use of resources," wrote Dr. Kathy Boutis, a pediatric emergency department physician at the Hospital for Sick Children and the University of Toronto, and colleagues.
The investigators applied the "low risk ankle rule" in more than 2,100 children, aged 3 to 16, who arrived at six Canadian emergency departments with non-penetrating ankle injuries.
The rule states that if an examination of a child's injured ankle suggests that there is a low risk of fracture, an X-ray may not be necessary. If doctors miss a certain category of fractures, evidence shows that they are stable, pose a low risk for any future problems, and can be treated like an ankle sprain.
The 22 percent reduction in the use of X-rays when using the rule was consistent in the different emergency departments.
"The ankle rule has potential broad applicability to emergency departments throughout most of the developed world, and widespread implementation of this rule could safely lead to reduction of unnecessary radiography in this radiosensitive population and a more efficient use of health care resources," the researchers concluded.
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