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Black and white: how good are clinicians at diagnosing elbow injuries from paediatric elbow radiographs alone?
  1. Lisa Dann1,
  2. Sarah Edwards2,
  3. Dani Hall1,3,
  4. Tessa Davis4,
  5. Damian Roland5,6,
  6. Michael Barrett7,8
  1. 1 Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland
  2. 2 Emergency Department, Leicester Royal Infirmary, Leicester, UK
  3. 3 University College Dublin, Dublin, Ireland
  4. 4 Emergency Department, Barts Health NHS Trust, London, UK
  5. 5 Health Sciences, University of Leicester, Leicester, UK
  6. 6 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
  7. 7 Emergency Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
  8. 8 Women’s and Children’s Health, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Lisa Dann; lisa_dann{at}hotmail.com

Abstract

Objectives Paediatric trauma elbow radiographs are difficult to interpret and there is a potential for harm if misdiagnosed. The primary goal of this study was to assess the ability of healthcare professionals internationally to interpret paediatric trauma elbow radiographs from the radiograph alone by formulating the correct diagnosis.

Methods This prospective international study was conducted online via the Free Open Access Medical Education platform, Don’t Forget the Bubbles (DFTB, ISSN 2754-5407). Participants were recruited via the DFTB social media accounts between 17 August and 14 September 2021. Submissions that were incomplete or from participants who do not interpret paediatric elbow radiographs in their clinical practice were excluded. Participants completed an online survey of demographic data followed by interpreting 10 trauma-indicated elbow radiographs, by selecting multiple-choice options. The primary outcome was correct diagnosis.

Results Participant responses from 18 countries were analysed, with most responses from the UK, Australia and Ireland. Participants had backgrounds in emergency medicine (EM), paediatric emergency medicine (PEM), general practice (GP) and paediatrics, with over 70% having 6+ years of postgraduate experience. 3180 radiographs were interpreted by 318 healthcare professionals. Only nine (2.8%) participants correctly diagnosed all 10. The mean number of radiographs correctly interpreted was 5.44 (SD 2.3). The mean number for those with 6+ years of experience was 6.02 (SD 2.2). On reviewing the normal radiograph, 158 (49.7%) overcalled injuries. Participants with EM or PEM background were equally likely to have more correct answers than those from paediatric or GP backgrounds.

Conclusion Globally, healthcare professional’s success in correctly diagnosing paediatric elbow injuries from radiographs was suboptimal in this non-clinical exercise, despite capturing quite an experienced cohort of clinicians. This study has provided us with detailed baseline data to accurately assess the impact of interventions aimed at improving clinicians’ interpretation of paediatric elbow radiographs in future studies.

  • trauma
  • x-ray
  • pediatric emergency medicine
  • pediatric injury

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data included in the study and full data available on request.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data included in the study and full data available on request.

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Footnotes

  • Handling editor David Metcalfe

  • X @drsarahedwards, @damian_roland, @DrMBarrett

  • Contributors LD and MB conceived the study and oversaw direction and planning with guidance and assistance from DH, DR and TD. LD selected the images and formulated the study protocol. TD assisted in the technical delivery of the online survey. LD and SE analysed the results with the assistance of a biostatistician, Aidan Beegan. LD and MB wrote the manuscript with input from all authors. LD is the content guarantor, responsible for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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