Emergency Room Plain Radiograph Imaging Study Indications: An Analysis of Quality and Trends at a Large Academic Medical Center

Rationale and Objectives This study aimed to assess the quality of and analyze trends among clinical indications received for emergency room radiograph studies. Materials and Methods Clinical indications provided by the emergency room and rapid care for consecutive chest, abdominal, and musculoskeletal radiographs were reviewed. Chart review was performed to analyze the provided indications compared to clinical information known to the ordering providers. Chest and abdominal radiograph indications were graded according to symptoms and physical examination signs and relevant past medical history. Musculoskeletal indications were graded according to symptoms, mechanism of injury, and positive physical examination findings. Each study indication was graded on a scale from 0 to 2 according to scales modified from those of prior published studies. Grades were further stratified according to ordering location, time of shift, ordering provider level, and specific anatomy involved. Results For chest and abdomen studies, mean scores for symptom and physical examination and provided past medical history grades were 1.16 and 0.36, respectively. There was a trend toward a significant difference in mean medical history grades among ordering provider levels. For musculoskeletal studies, mean scores for symptom, mechanism, and physical examination grades were 1.04, 0.89, and 0.51, respectively. Mean symptom and examination grades for physician extenders were significantly less than those of attendings and residents. Mean symptom and mechanism grades for extremity studies were significantly less than those for spinal studies. Conclusions For plain radiographs ordered through the emergency department, certain critical pieces of study indications tended to be underreported relative to other components. Furthermore, significant differences in select categories were seen among ordering provider levels and anatomic location.