thIne ED, unconfirmed pediatric X-ray reads can result in adverse events

Takeaway

• Of emergency physician (EP) interpretations of pediatric extremity X-rays, about 1 in 12 is discordant with final reads and results in an adverse event (AE).
• EPs should be especially cautious with joint injuries and if clinical fracture suspicion is low.

Why this matters

• Errors in pediatric fracture management are the third most common cause of US lawsuits.
• Few prospective data address such errors.

Key results

• Discordant reads associated with AEs: 7.8% (n=180; 95% CI, 6.8%-9.0%).
  • 101 fractures were missed, of which 6 were severe.
  • 22 fractures were read as more minor by EP than radiologist.
  • EPs called 57 false-positive fractures.
• AEs comprised additional ED visits and unnecessary orthopedic visits.
• No adverse clinical outcomes.
• Discordant reads likelier if:
  • Fracture pretest probability <20% vs >20% (aOR, 1.6).
  • Patient pain score <2 vs >2 (aOR, 1.6).
  • Injury in joint vs other location (aOR, 1.7).

Study design

• Prospective cohort study of children with injured extremities presenting to a pediatric emergency department (n=2302).
• Authors compared EP reads of radiographs vs radiology interpretation.
• Outcomes: discordant reads resulting in AEs (extra or unneeded visits or clinical sequelae) by 3-week mark.
• Funding: None disclosed.

Limitations

• Single-center study.
• Telephone follow-up incomplete, may have missed AEs.