Use of radiography in acute ankle injuries: physicians' attitudes and practice

摘要: OBJECTIVES: To examine the efficiency of current use radiography in patients with acute ankle injury. study judgements and attitudes experienced clinicians their to thereby assess potential for improved efficiency. DESIGN: Two-stage study: retrospective chart review prospective survey. SETTING: Emergency departments two adult teaching hospitals one community hospital. PARTICIPANTS: The records 1831 adults presenting blunt trauma over 5 months were examined; another 732 seen by 21 full-time emergency staff physicians a subsequent 6-month period. MEASURES AND MAIN RESULTS: Of an injury stage 1, 94.9% had at least radiographic series; yield clinically important fractures was 12.8%. In 2, predicted probability fracture be 0% or 10% 57.8% cases. kappa (kappa) level interobserver agreement 98 independently 0.55 (95% confidence interval [CI] 0.39 0.72). area under receiver operating characteristic curve physicians9 0.88 CI 0.84 0.92), reflecting good discrimination between nonfracture Likelihood ratios probabilities ranged from 0.08 151 100% level. indicated that they would feel comfortable very not ordering 45.9% cases (kappa 0.52; 95% 0.34 0.70). CONCLUSIONS: order most even though can accurately discriminate clearly expect radiographs give normal results. These findings suggest great more efficient injury, possibly through guidelines.