Lynch Brian C, Bowen Stephen, Coden Gloria, Botros Daniel, Komatsu David, Carrion Wesley
Stony Brook University Department of Orthopaedics and Rehabilitation, Stony Brook, NY, USA.
New England Baptist Hospital, Boston, MA, USA.
J Pediatr Soc North Am. 2024 Mar 24;7:100025. doi: 10.1016/j.jposna.2024.100025. eCollection 2024 May.
It is estimated that $12.8 billion to $28.6 billion is wasted annually on unnecessary imaging studies and treatment in the United States. This is especially important to the pediatric population, which is unable to make decisions for themselves and vulnerable to radiation exposure. We hypothesized that a significant number of unnecessary radiographs are performed in the pediatric emergency department (ED), leading to excessive time, cost, and radiation exposure to pediatric patients.
We retrospectively reviewed 406 patients who were evaluated in a pediatric ED for possible fractures at a single institution during the 2020 calendar year. Records were reviewed for demographics, history, and physical exams, as well as the sequential order which radiographs were performed. All radiographs were evaluated by the senior author to determine if they resulted in a change in management. All data were recorded and analyzed by the senior author and our statistician using Student's t-test.
406 patient encounters were included. 2,807 radiographs were deemed unnecessary, with an average of 6.9 radiographs per patient. $454,734 was spent on radiographs that ultimately did not change management. A total of 216 hours and 43 minutes was spent in the X-ray suite alone, for an average of 32 minutes per patient. The estimated amount of radiation exposure that did not change management was potentially as high as 69 millirem per patient.
There is an excessive amount of monetary waste, radiation exposure, and encounter time spent with pediatric Orthopaedic patients in the ED. There are several potential strategies to alleviate this problem, which we hope can be taken into consideration to help address this widespread health care issue.
(1)There are a substantial number of unnecessary radiographs performed in the pediatric ED both during diagnosis and treatment of fractures.(2)This unnecessarily increases the time, cost, and radiation exposure that pediatric patients experience.(3)Several possible strategies exist to reduce this waste including obtaining films after a careful physical exam, consider which views would be most beneficial, whether the joint above and below would truly be needed, using fluoroscopy in the ED during reduction and casting and limiting post splinting or casting imaging if there was no or minimal formal reduction.
III.
据估计，美国每年在不必要的影像学检查和治疗上浪费128亿至286亿美元。这对儿科人群尤为重要，因为他们无法自己做决定，且易受辐射暴露影响。我们推测，儿科急诊科（ED）存在大量不必要的X光检查，导致儿科患者花费过多时间、成本，并受到过多辐射。
我们回顾性分析了2020年在一家机构的儿科急诊科因可能骨折接受评估的406例患者。查阅记录中的人口统计学信息、病史和体格检查情况，以及X光检查的先后顺序。所有X光片均由资深作者评估，以确定其是否导致治疗方案的改变。所有数据由资深作者和我们的统计学家使用学生t检验进行记录和分析。
纳入406例患者就诊记录。2807张X光片被认为是不必要的，平均每位患者6.9张。最终未改变治疗方案的X光检查花费了454,734美元。仅在X光检查室就总共花费了216小时43分钟，平均每位患者32分钟。未改变治疗方案的估计辐射暴露量可能高达每位患者69毫雷姆。
在急诊科，儿科骨科患者存在大量金钱浪费、辐射暴露和就诊时间过长的问题。有几种潜在策略可缓解此问题，我们希望这些策略能被考虑用于解决这一普遍的医疗保健问题。
（1）在儿科急诊科对骨折进行诊断和治疗期间，存在大量不必要的X光检查。（2）这不必要地增加了儿科患者的时间、成本和辐射暴露。（3）存在几种可能的策略来减少这种浪费，包括在仔细体格检查后获取X光片、考虑哪些视图最有益、是否真的需要上下关节的X光片、在急诊科复位和打石膏期间使用荧光透视，以及如果没有或仅有极少的正式复位则限制夹板固定或打石膏后的成像检查。
III级。
