School of Medicine and Health Sciences Poster Presentations

Title

High Number of Negative Radiographs for Suspected Tibial Shaft Fracture Adds Expense and Increases Patient Throughput Time in the Emergency Department

Document Type

Poster

Abstract Category

Clinical Specialties

Keywords

Tibia, fracture, emergency, x-ray, radiograph

Publication Date

Spring 5-1-2019

Abstract

Purpose: Tibial shaft fractures (OTA 42A-C) are the most common long bone fracture in adults, and the diagnosis is commonly made by emergency department (ED) providers prior to orthopedic consultation. Due to the subcutaneous anatomy of the tibia, a comprehensive history and physical examination are often sufficient for fracture diagnosis, with radiographs serving as a secondary aid in confirming the diagnosis and planning treatment. Although it is expected that some of these radiographic studies will be negative despite clinical suspicion for fracture, a high rate of negative X-Rays increases cost and inefficiency in the ED. This study aims to define the rate at which tibial radiographs are negative for fracture at a Level I trauma center. Secondary objectives include assessment of cost, resource allocation, and radiation exposure associated with these negative X-Rays. Finally, we present diagnostic criteria to guide the clinician in efficiently obtaining tibial radiographs. Methods: At a Level I trauma center, a prospective database was retrospectively evaluated for ED radiographs taken from 2014 to 2017. The number of radiographs taken for suspected trauma to the tibial diaphysis in the absence of concomitant periarticular injury was recorded. From this group, the percentage of X-rays positive for tibia fracture was determined. The increased cost, ED throughput time, resource utilization, and radiation exposure was analyzed. Results: During the three year study period, 734 tibia radiographs were performed in the ED for diagnosis of tibial shaft fracture. Of these, 565 (76.9%) were negative for tibial shaft fracture. Patient charges were increased from these negative radiographs through both higher radiology charges ($598 per tibia radiographic series) and higher professional charges. The average time to obtain a tibia X-ray series in the ED was 28 minutes (range: 13-74 minutes). The radiation exposure from a tibia radiographic series was found to be 15 millirems. Conclusion: At this institution, a large proportion of the radiographs obtained for suspected tibial shaft fracture are negative. The resources and time spent acquiring these radiographs places higher demands on physicians and staff and increases charges and radiation exposure to the patient. In addition, these negative radiographs add throughput time in the ED, thereby potentially contributing to ED overcrowding. Given the subcutaneous nature of the tibia, diagnosis of tibial shaft fracture is often reliably made through history and physical examination. We propose a systematic approach to maximize the diagnostic efficiency of tibia radiographs and subsequently improve resource allocation in the ED.

Open Access

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Presented at Research Days 2019.

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High Number of Negative Radiographs for Suspected Tibial Shaft Fracture Adds Expense and Increases Patient Throughput Time in the Emergency Department

Purpose: Tibial shaft fractures (OTA 42A-C) are the most common long bone fracture in adults, and the diagnosis is commonly made by emergency department (ED) providers prior to orthopedic consultation. Due to the subcutaneous anatomy of the tibia, a comprehensive history and physical examination are often sufficient for fracture diagnosis, with radiographs serving as a secondary aid in confirming the diagnosis and planning treatment. Although it is expected that some of these radiographic studies will be negative despite clinical suspicion for fracture, a high rate of negative X-Rays increases cost and inefficiency in the ED. This study aims to define the rate at which tibial radiographs are negative for fracture at a Level I trauma center. Secondary objectives include assessment of cost, resource allocation, and radiation exposure associated with these negative X-Rays. Finally, we present diagnostic criteria to guide the clinician in efficiently obtaining tibial radiographs. Methods: At a Level I trauma center, a prospective database was retrospectively evaluated for ED radiographs taken from 2014 to 2017. The number of radiographs taken for suspected trauma to the tibial diaphysis in the absence of concomitant periarticular injury was recorded. From this group, the percentage of X-rays positive for tibia fracture was determined. The increased cost, ED throughput time, resource utilization, and radiation exposure was analyzed. Results: During the three year study period, 734 tibia radiographs were performed in the ED for diagnosis of tibial shaft fracture. Of these, 565 (76.9%) were negative for tibial shaft fracture. Patient charges were increased from these negative radiographs through both higher radiology charges ($598 per tibia radiographic series) and higher professional charges. The average time to obtain a tibia X-ray series in the ED was 28 minutes (range: 13-74 minutes). The radiation exposure from a tibia radiographic series was found to be 15 millirems. Conclusion: At this institution, a large proportion of the radiographs obtained for suspected tibial shaft fracture are negative. The resources and time spent acquiring these radiographs places higher demands on physicians and staff and increases charges and radiation exposure to the patient. In addition, these negative radiographs add throughput time in the ED, thereby potentially contributing to ED overcrowding. Given the subcutaneous nature of the tibia, diagnosis of tibial shaft fracture is often reliably made through history and physical examination. We propose a systematic approach to maximize the diagnostic efficiency of tibia radiographs and subsequently improve resource allocation in the ED.