News | Sunday, 22 March 2009

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22% of X-rays on foot injuries could be avoided

James Debono
22% of X-rays for foot and ankle injuries in hospital could be avoided if international guidelines determining which cases require an X-ray are adhered to.
This is the conclusion of a study by Malcolm Borg and Agnes Cachia Pickard from the Accident and Emergency Department of Mater Dei, published in the latest edition of the Malta Medical Journal.
The study found that of the 73 patients presenting themselves with ankle injuries between 1 August and 15 September 2006, 69 (95%) had to undergo X-rays.
Of these, 12 (19.4%) did not require an X-ray according to the criteria established by the Ottowa Ankle Rule. Of the 28 foot X-rays performed, nine (32.1%) could have been avoided according the same international convention.
The Ottawa ankle rules are a set of guidelines for doctors to aid them in deciding if a patient with foot or ankle pain should be offered an X-ray to diagnose a possible bone fracture.
Before the introduction of the rules most patients with ankle injuries would have been X-rayed. However only about 15% of X-rays were positive for fracture, other patients had sprains or other injuries. As a result many unnecessary X-rays were taken, which was costly, time-consuming and a possible health risk.
The authors of the study recommend a strategy to implement the OAR in Malta through an information campaign which should include lectures in the induction period of medical and nursing staff in the A&E Department.
Although exposure to X-rays is not deemed exceptionally harmful, it is expensive to perform and best avoided.
A similar study published last year showed that a total of 312 out of 387 patients who presented themselves with a head injury in the emergency department had their skulls X-rayed. The authors of the report revealed that if international guidelines were strictly abided to, only two of those patients would have required an X-ray.
Another study found on the financial implications of nasal fractures at St Luke’s Hospital (SLH) found that only 16% of the patients who had X-rays of their nasal injuries taken, needed surgical intervention. The doctors warned that patients attending the Accident & Emergency Department with nasal injuries “should not routinely have radiological examinations unless requested by a specialist”.
Nasal injuries are the third most common type of fractures, usually due to traffic accidents, falls, and fights, leading to numerous patient visits at the hospital emergency department. In 2006 there were 278 x-rays of nasal bones taken at St Luke’s emergency department. This strongly contrasted with the 46 operations conducted on nasal fractures.

jdebono@mediatoday.com.mt

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