Comparison views to diagnose elbow injuries in children: a survey of Canadian non-pediatric emergency physicians

Abstract

Elbow injuries in children are a common presenting complaint to the emergency department. Although radiography is a valuable tool in the diagnosis of this injury, x-rays of the injured elbow are inherently difficult to interpret. As a result, comparison views of the uninjured arm have traditionally been recommended to provide an anatomically "normal" radiograph. Recent studies have questioned the use of comparison views in the pediatric emergency department. The primary objective of this study was to determine current practices of non-pediatric emergency physicians in the use of comparison views for the diagnosis of elbow injuries in children. A self-administered mail survey was sent to 300 randomly selected emergency physicians, using the Canadian Association of Emergency Physicians database. Two hundred and forty-two (81%) responses were received; 26 were excluded based on pre-determined criteria. Of eligible respondents, 95% ordered comparison views selectively and 64% of these physicians ordered comparison views infrequently. Eighty-eight percent found the comparison views to be "rarely" to "sometimes" useful. Forty-seven percent of respondents stated that they were only "somewhat" confident when interpreting x-rays of a child's elbow. This survey demonstrates that non-pediatric emergency physicians are using comparison views selectively for elbow injuries in children, despite being only "somewhat" confident in interpreting the x-rays.