Factors Associated with Radiologic Tests in Patients with Radial Head Subluxation

요골두아탈구 환자에서 방사선 검사 시행과 연관된 인자 분석

  • Chang, Ikwan (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Kim, Do Kyun (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Park, So Young (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Suh, Dongbum (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Jung, Jae Yun (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Kwak, Young Ho (Department of Emergency Medicine, Seoul National University College of Medicine)
  • 장익완 (서울대학교 의과대학 응급의학교실) ;
  • 김도균 (서울대학교 의과대학 응급의학교실) ;
  • 박소영 (서울대학교 의과대학 응급의학교실) ;
  • 서동범 (서울대학교 의과대학 응급의학교실) ;
  • 정재윤 (서울대학교 의과대학 응급의학교실) ;
  • 곽영호 (서울대학교 의과대학 응급의학교실)
  • Received : 2014.01.14
  • Accepted : 2014.06.10
  • Published : 2014.06.30

Abstract

Purpose: In general, X-ray examinations are not recommended for radial head subluxation (pulled elbow) patients. The purpose of this study was to determine the frequency of X-ray examinations and to investigate the factors associated with the decision to perform an X-ray examination on a patient with a pulled elbow. Methods: Patients who visited the pediatric emergency department (ED) of one tertiary hospital from January 1, 2011, to December 31, 2012, with a diagnosis of radial head subluxation at discharge were enrolled in this study. Through retrospective chart reviews, factors that could have influenced the decision to perform an X-ray examination and their statistical relevance were analyzed. Results: A total 308 patients were enrolled, and 101 patients (32.8%) underwent X-ray examinations. Among the 252 patients with a typical pulled elbow, 65 underwent X-ray examination. This result showed statistical significance compared to atypical pull-elbow group (25.8% vs. 64.3%, p<0.001). Factors associated with the decision to perform an X-ray examination were analyzed using the Chi-square test and the Fisher's exact test. The mechanism of injury and consultation with an orthopedic surgeon (p=0.001) showed statistical significance. In the multivariable logistic regression, the odds ratio (OR) for the injury mechanism was 4.7 (95% CI: 1.8~8.8, p<0.001) and that for consultation with an orthopedic surgeon was 8.0 (95% CI: 1.6~40.7, p=0.004). Conclusion: One third of patients with a pulled elbow underwent X-ray examination, and patients with an atypical mechanism of injury underwent more frequent X-ray examinations than did patients with a typical mechanism of injury. The factors that could have influenced the decision to perform an X-ray examination were mechanism of injury and consultation with an orthopedic surgeon.

Keywords

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