Ruess Lynne, Chmil Margarita, Singh Satbir, Samora Julie B
Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio.
Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio.
Pediatr Qual Saf. 2022 Mar 30;7(2):e547. doi: 10.1097/pq9.0000000000000547. eCollection 2022 Mar-Apr.
Accurately distinguishing between stable and unstable isolated distal radius fractures (DRF) in children allows for appropriate fracture-specific treatment. Although fractures with cortical disruption, displacement, or angulation are unstable, distinguishing stable buckle fractures (BF) from more subtle potentially unstable DRF is challenging. Our quality improvement project aimed to improve radiology reporting accuracy for these subtle fractures from 23% to 90% in a large tertiary pediatric hospital.
Exams with a reported isolated distal radius fracture during baseline (January-March 2016) and intervention (April 2016-June 2019) were reviewed for accuracy. We introduced 3 types of interventions: radiologist education (self-directed learning modules and individual feedback), a new standardized report template, and a measurement tool ("The 1 cm Rule"). In addition, a statistical process control chart tracked accuracy data to study process changes over time.
During the baseline and intervention period, 22 and 480 radiographs, respectively, had either a stable BF or a potentially unstable isolated DRF. Each intervention type created a centerline shift. Overall, reporting accuracy increased from 23% to 90%. Most reports (95%, 639/676) used the template and standard terminology for reporting DRF.
Radiology reporting diagnostic accuracy for distinguishing between stable BF and potentially unstable DRF in children increased to 90% through education, standardized reporting, and a measurement tool to enhance radiologist performance. Our institution plans to expand fracture-specific treatment practices with improved radiology reporting accuracy, including bracing and home management of stable BF diagnosed during an acute care visit.
准确区分儿童稳定型和不稳定型孤立性桡骨远端骨折（DRF）有助于进行针对性的骨折治疗。虽然伴有皮质骨中断、移位或成角的骨折属于不稳定型，但区分稳定型青枝骨折（BF）与更隐匿的潜在不稳定型DRF具有挑战性。我们的质量改进项目旨在将一家大型三级儿童医院中这些隐匿性骨折的放射学报告准确率从23%提高到90%。
回顾基线期（2016年1月至3月）和干预期（2016年4月至2019年6月）报告为孤立性桡骨远端骨折的检查结果，评估其准确性。我们采取了三种干预措施：放射科医生培训（自主学习模块和个人反馈）、新的标准化报告模板以及一种测量工具（“1厘米规则”）。此外，通过统计过程控制图跟踪准确率数据，以研究随时间的过程变化。
在基线期和干预期，分别有22张和480张X线片显示为稳定型BF或潜在不稳定型孤立性DRF。每种干预措施都使中心线发生了偏移。总体而言，报告准确率从23%提高到了90%。大多数报告（95%，639/676）使用了模板和标准术语来报告DRF。
通过培训、标准化报告以及一种提高放射科医生表现的测量工具，区分儿童稳定型BF和潜在不稳定型DRF的放射学报告诊断准确率提高到了90%。我们机构计划扩大针对性骨折治疗方案，提高放射学报告准确率，包括对急性护理就诊时诊断出的稳定型BF进行支具固定和家庭护理。
