Utilization of radiographs for the diagnosis of ankle fractures in Kingston, Ontario, Canada

Abstract

Objectives: This study assessed the utilization and clinical yield of radiographs ordered to assist in the diagnosis of acute ankle injuries presenting to two emergency departments (EDs) in Kingston, Ontario, Canada, over a 7-year period. Methods: A large case series was assembled. Records of ankle injuries from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were linked to hospital discharge records containing procedure codes. Utilization of radiographs and the clinical yield of these assessments were analyzed over time. Results: Following exclusions, 7,706 acute ankle injuries were identified for analysis. Utilization of radiography increased modestly over time, to a high of 70.3% (95% confidence interval [CI] = 67.3% to 72.9%) in 2007. The percentage of cases positive for fracture remained consistent (18.3% to 21.9% annually). Conclusions: Explanations for the observed increase in utilization of radiographs remain uncertain. Increased use of clinical decision tools such as the Ottawa Ankle Rules (OAR) appear to be required to reduce procedure costs within the ED and to limit patient exposure to radiography. © 2011 by the Society for Academic Emergency Medicine.