Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Clavicle fractures are among the most common orthopedic injuries in children. Diagnosis typically involves radiographs, which expose children to radiation and may consume significant time and resources. Our objective was to determine if bedside emergency department (ED) ultrasound (US) is an accurate alternative to radiography. ⋯ Compared to radiographs, bedside US can accurately diagnose pediatric clavicle fractures. US causes no more discomfort than radiography when detecting clavicle fractures. Given US's advantage of no radiation, pediatric EPs should consider this application.
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The Low Risk Ankle Rule (LRAR) is a validated clinical decision rule (CDR) about the indications for ankle radiographs in children with acute blunt ankle trauma. Although application of the LRAR has the potential to safely reduce the rate of ankle radiography by 60%, current x-ray rates in most emergency departments (EDs) in the United States and Canada remain unnecessarily high (85%-100%). To evaluate this gap between knowledge and practice, physicians who treat pediatric ankle injuries in EDs were surveyed to determine physician awareness and use of the LRAR, acceptability of the LRAR as measured by the Ottawa Acceptability for Decision Rules Scale (OADRS), and perceived barriers to the use of a validated pediatric ankle x-ray rule. ⋯ Although the LRAR had a high acceptability score among respondents in this survey, this validated CDR is not widely known and is even less frequently applied by PEM physicians in the United States and Canada. Barriers were identified that will guide efforts to improve the knowledge translation of the LRAR into pediatric EDs.