Predicting the result of our X-rays, a way to identify overuse? the Ulster Hospital Dundonald.
OBJECTIVE
The objectives of the study were to identify areas of the unnecessary use of diagnostic plain X-rays in the emergency department. Requests for inappropriate plain X-ray investigations have resource, radiation and overcrowding implications for the emergency department.


METHODS
The junior doctor or nurse practitioner treating patients attending the emergency department requiring X-ray completed a proforma prospectively. Questions included the type of X-ray, predicted result of the X-ray and observed result of X-ray.


RESULTS
A total of 226 out of 280 X-rays (81%) were accurately predicted, 94 X-rays (34%) were abnormal. Facial bones (100%) and skull (79%) were most commonly X-rayed when the result was predicted accurately to be normal. The threshold for X-raying abdomen, kidney, ureter and bladder and lumbar spine was low with normal accurate predictions of 67, 75 and 75%, respectively. Normal knee and foot X-rays were predicted accurately in 61 and 60% of cases, respectively, with a yield of 28 and 13%, respectively.


CONCLUSIONS
The training of emergency medicine staff should include education about clinical indications from guidelines and recommendations about X-ray use, information on the dose of radiation exposure, implications of resources and overcrowding of departments.
Johnston
Jeremy J E
JJ
Accident and Emergency Department, Newcastle General Hospital, Westgate Road, Newcastle NE4 6BE, UK. jeremyjohnston@doctors.org.uk
D004635:Emergency Medicine / Q000379:methods; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008505:Medical Staff, Hospital; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography / Q000706:statistics & numerical data*; D018570:Risk Assessment; D006113:United Kingdom; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology