Utilization of Radiographs for the Diagnosis of Ankle Fractures in Kingston, Ontario, Canada

Authors

  • Hilary Dowdall,

    1. From the Department of Community Health and Epidemiology (HD, MG, RJB, WP) and the Department of Emergency Medicine (RJB, WP), Queen’s University, Kingston, Ontario, Canada.
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  • Marianne Gee MSc,

    1. From the Department of Community Health and Epidemiology (HD, MG, RJB, WP) and the Department of Emergency Medicine (RJB, WP), Queen’s University, Kingston, Ontario, Canada.
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  • Robert J. Brison MD, MPH,

    1. From the Department of Community Health and Epidemiology (HD, MG, RJB, WP) and the Department of Emergency Medicine (RJB, WP), Queen’s University, Kingston, Ontario, Canada.
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  • William Pickett PhD

    1. From the Department of Community Health and Epidemiology (HD, MG, RJB, WP) and the Department of Emergency Medicine (RJB, WP), Queen’s University, Kingston, Ontario, Canada.
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  • Presented at the 2010 Canadian Society of Epidemiology and Biostatistics Student Meeting, Kingston, Ontario, Canada, Spring 2010.

  • This work was supported by the Injury Section, Public Health Agency of Canada, who also fund The Canadian Hospitals Injury Reporting and Prevention Program.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Roland C. Merchant, MD, MPH, ScD.

Address for correspondence and reprints: Dr. William Pickett, PhD; e-mail: will.pickett@queensu.ca.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:555–558 © 2011 by the Society for Academic Emergency Medicine

Abstract

Objectives:  This study assessed the utilization and clinical yield of radiographs ordered to assist in the diagnosis of acute ankle injuries presenting to two emergency departments (EDs) in Kingston, Ontario, Canada, over a 7-year period.

Methods:  A large case series was assembled. Records of ankle injuries from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were linked to hospital discharge records containing procedure codes. Utilization of radiographs and the clinical yield of these assessments were analyzed over time.

Results:  Following exclusions, 7,706 acute ankle injuries were identified for analysis. Utilization of radiography increased modestly over time, to a high of 70.3% (95% confidence interval [CI] = 67.3% to 72.9%) in 2007. The percentage of cases positive for fracture remained consistent (18.3% to 21.9% annually).

Conclusions:  Explanations for the observed increase in utilization of radiographs remain uncertain. Increased use of clinical decision tools such as the Ottawa Ankle Rules (OAR) appear to be required to reduce procedure costs within the ED and to limit patient exposure to radiography.

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