X-Ray Utilization Patterns in Pediatric Musculoskeletal Trauma: Assessing Potential Overprescription

Background: Traumatic injuries are among the leading causes of visits to the pediatric emergency department (PED). Objectives: This study aims to evaluate the pediatric approach to musculoskeletal trauma in children to determine whether the routine use of X-rays can be reduced by encouraging the use of ultrasound. Methods: This retrospective observational study included children aged 0 - 18 years admitted to the PED of the Policlinico A. Gemelli with a diagnosis of musculoskeletal trauma from January 2017 to December 2021. Patients were divided into two groups based on the presence of fractures identified through radiological examinations: "Fracture Yes" and "Fracture No." Data on X-rays performed were categorized according to the site of trauma. Results: A total of 5,972 children were enrolled. The most notable findings concern the regions of trauma. Among 1,273 patients who underwent X-rays of the hand region, 617 (48%) showed fractures, and 656 (51%) did not. Of the 744 X-rays performed for the foot region, 235 (31%) revealed fractures, while 509 (68%) were negative for fractures. In the upper limbs region, 1,334 X-rays were performed, with 1,079 (80%) identifying fractures and 255 (20%) showing no fractures. For the lower limbs region, 479 X-rays were conducted, 204 (42%) of which revealed fractures, while 275 (58%) were negative for fractures. All these results demonstrated statistically significant differences (P < 0.05). Conclusions: Despite the limitations of the study's retrospective design and its single-center setting, the findings highlight a high prevalence of X-rays in the hand and upper limb regions, often with positive results. In contrast, radiography of the lower limbs and feet frequently yielded negative findings, suggesting potential overuse. Future research should investigate the clinical utility of musculoskeletal ultrasound as an alternative imaging modality to minimize unnecessary radiation exposure in pediatric patients.