Can physician and patient gestalt lead to a shared decision to reduce unnecessary radiography in extremity trauma?

Abstract

Minor musculoskeletal injury is one of the most common presentations to the emergency department (ED). The majority (85%-90%) of those presenting for minor injury do not have a fracture [1], and presumably, many others never seek medical attention. The need to image patients with obvious signs of fracture is never in question—but it is much less clear who needs imaging when those signs are absent. This leads to considerable practice variability and, in the United States, is complicated further by the need to address patient satisfaction. The notion that patients might help risk-stratify their own case in the setting of trauma by answering the question “do you think you have anything broken?” has not been formally investigated. Querying the patient about their perception of the severity of their injury can lead to shared decision making (SDM) regarding the need for imaging and might reduce unnecessary imaging by simplifying the process for physicians and for triage nurses in departments with triage protocols. This investigation was designed to explore the utility of using both the patient's perception of the severity of their injury and the provider's perception of that severity, to help decidewhether to obtain imaging. Specifically, we hypothesized that when the patient felt they did not have a fracture or the provider predicted “b10%” likelihood, that the incidence of fracture would be extremely low.