EVALUATION OF THE ROLE OF COMPARISON RADIOGRAPHS IN THE DIAGNOSIS OF TRAUMATIC ELBOW INJURIES

This study attempted to determine whether comparison radiographic view s of the uninjured elbow result in increased diagnostic accuracy. Phys icians (one junior and one senior orthopaedic resident and an orthopae dic surgeon) were provided with a short clinical summary and asked to interpret radiographs of the injured elbow (IE) or both the injured an d uninjured elbow (UE) in a randomized fashion from 25 children with e lbow injuries. The overall percentage of correct diagnoses (one vs. tw o elbow radiographs) were as follows: orthopaedic surgeon, 80 versus 9 6%; for junior resident, 80 versus 84%; and for senior resident, 84 ve rsus 88% (p > 0.05). Kappa scores for interobserver variability and in trarater agreement were in the high range (0.756 to 0.904, kappa = 0.0 8). Clinically relevant diagnoses were missed by trainees (not the ort hopaedic surgeon) whether radiographs of IE or both IE and UE were int erpreted. Incorrect radiograph interpretations were due to false posit ives in 39 of 40 cases. Comparison radiographs of the UE were not usef ul in improving diagnostic accuracy in elbow trauma. However, although they may be necessary in some instances, routine radiographic examina tion of the UE is not warranted.