Brand et al proposed a protocol for performing X-rays on patients with an injured extremity. This was intended to reduce the number of unnecessary radiographic examinations.
Study population: 848 patients with 1235 injuries
Site of Injury
Criteria
upper or lower extremity
bone deformity
bone instability
crepitation
point tenderness
upper extremity only
ecchymosis in an upper extremity
severe swelling in an upper extremity
lower extremity only
moderate to severe pain on weight bearing in a hip or thigh
any positive finding in a knee
number of positive criteria =
= SUM(number of findings present)
Interpretation:
• high risk = presence of one or more positive criteria
• low risk = no positive criteria present
• An X-ray is recommended if the injury is high risk.
• The protocol could have reduced X-ray usage by 12% for upper extremity studies and 19% for lower extremity studies.
• 1 fracture in 287 was missed, but the treatment given was appropriate and the outcome was satisfactory.
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