Ankle X-ray use at Mater Dei's accident and emergency department

Aim: To determine the amount of X-rays performed at the Accident and Emergency Department (A&E) at Mater Dei Hospital to investigate ankle injuries. Objectives: A comparison between the X-ray report and the examining physician’s request was also performed. The audit will propose the possibility of implementing a standard protocol of care for ankle injuries namely, based upon the Ottawa Ankle Rules. Methods: A retrospective observational study was carried out between the 20th September and the 20th December 2015. All ankle X-rays performed at A&E during this period were analysed using the Picture and Archiving System (PACS). Results: The commonest reason for requesting an X-ray following a traumatic event was to identify the presence of a fracture. Only 27.8% of these X-ray reports identified a fracture. X-rays were also requested for non-traumatic injuries very often due to swelling. Physicians’ requests often contained minimal clinical details but only one request had no details whatsoever. Conclusion: Ankle X-rays were most commonly performed to identify a fracture but very often no fracture was identified. Fractures were a relatively uncommon finding raising the possibility of inappropriate prescription of X-rays. Use of guidelines or an alternative investigation could be beneficial in order to reduce inappropriate radiography usage. Appropriately filled in request forms including clinical presentation would help the communication between the physician and the radiologist.peer-reviewe