Rate of abnormal osteoarticular radiographic findings in pediatric patients

OBJECTIVE. The objective of our study was to assess the rate of abnormal ra diographic findings in the most frequent osteoarticular locations of trauma tic injury in a pediatric population. SUBJECTS AND METHODS. During two periods of 12 weeks each, all patients adm itted to the pediatric emergency department for osteoarticular trauma who u nderwent radiography were prospectively included in this study. A connectio n was drawn between the rate of abnormal radiographic findings for the seve n most frequently radiographed locations and the clinical findings. RESULTS. Of 3128 locations of trauma in 2470 children, only 22% of the radi ographic examinations were considered to reveal abnormal findings. In decre asing order, the hand and fingers, the ankle, the wrist, the knee, the elbo w, the foot and toes, and the forearm were the most frequently examined loc ations, The rate of abnormal findings was 25.7% for the hand and fingers, 9 .0% for the ankle, 42.5% for the wrist, 9.5% for the knee, 33.3% for the el bow, 18.3% for the foot, and 43.2% for the forearm. When only the direct si gn of fracture was taken into account, these rates decreased for the ankle and knee to 2.6% and 1.9%, respectively, There was always a significant lin k between the degree of clinical suspicion and the rate of abnormal radiogr aphic findings. However, fewer than 50% of the cases with high clinical sus picion of fracture were radiographically confirmed. CONCLUSION. It appears necessary, especially in cases of lower limb trauma, to evaluate clinical tests, including the implementation of the Ottawa ank le rules, to reduce the number of unnecessary radiographic examinations, Th is reduction will improve some parameters of children's quality of life and will significantly decrease the cost of emergency care.