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Rate of Abnormal Osteoarticular Radiographic Findings in Pediatric Patients

¹ Service de Radiologie Pédiatrique, Hôpital Timone-Enfants, 256 Bd. Jean Moulin, 13385 Cedex 5, Marseille, France.
² Unité Mixte de Recherche no. 6578 CNRS, Université de la Méditerranée, Marseille, France.
³ Service de Santé Publique, Université de la Méditerranée, Marseille, France.
⁴ Service de Radiologie, Chemin des Bourrely, Hôpital Nord, Marseille, France.

OBJECTIVE. The objective of our study was to assess the rate of abnormal radiographic findings in the most frequent osteoarticular locations of traumatic injury in a pediatric population.

SUBJECTS AND METHODS. During two periods of 12 weeks each, all patients admitted to the pediatric emergency department for osteoarticular trauma who underwent radiography were prospectively included in this study. A connection was drawn between the rate of abnormal radiographic findings for the seven most frequently radiographed locations and the clinical findings.

RESULTS. Of 3128 locations of trauma in 2470 children, only 22% of the radiographic examinations were considered to reveal abnormal findings. In decreasing order, the hand and fingers, the ankle, the wrist, the knee, the elbow, the foot and toes, and the forearm were the most frequently examined locations. 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 elbow, 18.3% for the foot, and 43.2% for the forearm. When only the direct sign 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 link between the degree of clinical suspicion and the rate of abnormal radiographic findings. However, fewer than 50% of the cases with high clinical suspicion 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 ankle rules, to reduce the number of unnecessary radiographic examinations. This reduction will improve some parameters of children's quality of life and will significantly decrease the cost of emergency care.

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