Is there benefit to concurrent imaging of the wrist and elbow in paediatric trauma patients?

Abstract

Purpose: To determine if a significant number of unexpected injuries are found by performing concurrent imaging of the elbow and wrist in paediatric trauma patients with suspected injury to only one of these regions. This protocol is commonly used in paediatric care centres, despite a lack of evidence to support its efficacy.1 Can comprehensive clinical examination of the elbow and wrist be relied upon to exclude an injury and thus the need for additional imaging? Methods and materials: A retrospective review was conducted of all paediatric patients, aged between 1-16 years, that presented to the Logan Hospital Emergency Department and had imaging of their upper limb performed between March 1st 2016 and September 1st 2016. Patients were selected by screening the electronic imaging database at Logan Hospital for forearm, elbow or wrist imaging. These images were reviewed on the Logan Hospital picture archiving and communication system (PACS) to confirm the presence of an injury. If an injury was found, the patients' electronic charts were reviewed to determine if the injury was unsuspected, based on correlation with clinical examination findings. Results: A total of 464 children had imaging of their elbow, wrist or forearm at Logan Hospital between March 1st 2016 and September 1st 2016. 41 patients were excluded from the audit as they had imaging performed for a non-traumatic indication. 423 patients composed the total study population. 83% of the total study population (351 patients) had imaging of both the elbow and wrist performed. Of these patients, 208 (59%) were found to have an injury (179) or high suspicion of an injury (29), whilst 143 (41%) were identified as having no injury. 10 of these patients (4.8% of those with an injury) were identified as having an unsuspected injury of their elbow or forearm, or suspicion of such, on additional radiographs. 2 of these 10 patients (0.96% of those with an injury) had concomitant ipsilateral injuries. Conclusion: This audit raises doubt regarding the benefit of concurrent imaging of the wrist and elbow in paediatric trauma patients with suspected injury to only one of these regions based on physical examination findings. Considering the bias inherent in the retrospective nature of this audit and potential complications of a missed injury,2,3 further prospective studies are required to confirm the validity of these results. This could then prompt appropriate changes to the current imaging protocol widely used across paediatric imaging centres in Queensland.L6189770352017-11-01 <br />