title: Number of positive radiographic findings in pediatric trauma patients.
abstract: OBJECTIVE
  Conventional radiography is frequently performed in pediatric patients in whom fractures and dislocations are suspected. However, until now, the rate of positive findings of the most commonly performed radiographic examinations in pediatric patients is unknown. The aim of this study was to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center systematically.
  
  
  METHODS
  A transversal cohort study was conducted at a level 1 trauma center in Germany (2008-2014). In a statistical pre hoc analysis, a sample size of 200 images of each standard radiograph was determined. The picture archiving and communication system (PACS) was searched for radiographic examinations in patients under 18 years.
  
  
  RESULTS
  The following fracture rates for the investigated 20 most common examinations were found: 70.5% clavicle, 54.5% forearm, 53% wrist, 41.5% elbow, 30.5% lower leg, 20% hand, 18.5% finger, 12.5% toe, 12% forefoot, 11.5% ankle, 9% shoulder, 6.5% patella, 5.5% foot, 4% knee, 2% conventional rib series, 1.5% lumbar spine, 1% Towne view, 0.5% skull, 0% cervical spine, and 0% odontoid. Differences in the mean age of analyzed pediatric trauma patients in correlation to different standard radiographs were found.
  
  
  CONCLUSIONS
  In our study, a relevant amount of different standard radiographs revealed a low fracture rate. Therefore, indications for X-ray should be checked properly and alternative procedures should be discussed with the patient and the parents. Clinical decision rules should be developed and pathways have to be implemented to minimize radiation exposure, waiting time, and costs.
authors.affiliation: Department of Trauma and Orthopedic Surgery 1; Westpfalz-Klinikum, Teaching Hospital of the Medical Faculty Mannheim, University of Heidelberg and of the University of Mainz, Hellmut-Hartert-Str.1, Kaiserslautern, Germany. thomas@ruffing.eu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruffing
authors.affiliation: Department of Trauma and Orthopedic Surgery 1; Westpfalz-Klinikum, Teaching Hospital of the Medical Faculty Mannheim, University of Heidelberg and of the University of Mainz, Hellmut-Hartert-Str.1, Kaiserslautern, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Danko
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
authors.affiliation: Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Department of Trauma and Orthopedic Surgery 1; Westpfalz-Klinikum, Teaching Hospital of the Medical Faculty Mannheim, University of Heidelberg and of the University of Mainz, Hellmut-Hartert-Str.1, Kaiserslautern, Germany.|Medical Faculty, University of Mainz, Mainz, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hofmann
authors.affiliation: Department of Trauma and Orthopedic Surgery 1; Westpfalz-Klinikum, Teaching Hospital of the Medical Faculty Mannheim, University of Heidelberg and of the University of Mainz, Hellmut-Hartert-Str.1, Kaiserslautern, Germany.|Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Muhm
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D014193:Trauma Centers
keywords: Emergency department; Fracture rate; Pediatric trauma; Standard radiographs