Aims In the context of trauma, plain facial X-rays do not represent the gold standard imaging modality, as many patients with equivocal findings will require further imaging with facial CT views. The aim of this project was to review the use of facial X-rays of patients seen in a paediatric ED following trauma, to ascertain the degree of correlation between clinical signs and radiological findings.
Methods Retrospective review. All facial X-rays performed within the ED over a 1 year period (09/2012–09/2013) were identified from the hospital PACS system. Clinical details were obtained from the ED notes and compared with the X-ray report from a consultant radiologist.
Results See Figure 1 below.
Conclusions The vast majority of facial X-rays performed in our ED showed no evidence of fracture. A negative X-ray may be falsely reassuring as, in some cases, clinical suspicion of bony injury was high, but no further investigation/referral was made. In other cases, a facial CT was performed despite a negative facial X-ray. Therefore, in general, facial X-rays and their interpretation by ED clinicians do not appear to make a significant difference to the subsequent clinical management of patients. If suspicion of fracture is high then CT would be a better imaging modality, as where suspicion remains high an equivocal plain X-ray result would not confidently exclude facial bone fracture.
On the basis of this we have developed a new clinical guideline which stratifies patients into 3 management paths according to clinical signs and symptoms:
Our intention is to reduce the number of unnecessary facial X-rays, and practice will be re-audited one year post- implementation.
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