David A. Vuijk (Leiden / NL), Noë J. Eggebeen (Leiden / NL), Pieta Krijnen (Leiden / NL), Inger B. Schipper (Leiden / NL), Marco F. Termaat (Leiden / NL)
Abstract text (incl. references and figure legends)
Introduction
Omitting routine radiographs after the initial 2 weeks of follow-up (FU) in patients with ankle and wrist fractures has proven not to affect patient-reported outcome.1,2 We developed a focused de-implementation strategy based on the known facilitators/barriers.3 This study aims to assess the classical de-implementation (DI) of routine radiographs for wrist and ankle fractures and the added value of a focused strategy in clinical practice.
Material & Methods
This descriptive retrospective multicenter cohort study included patients with either a non-weber A type ankle fracture (AF) or distal radius fracture (DRF). Patients with open fractures, pathological fractures, or an ISS≥16 were excluded. The primary outcome was the number of routine radiographs, two weeks after trauma, during 3 different research phases: at baseline (before DI), after classical DI, and after the focused DI strategy. Radiographs were indicated as routine if no clinical indication was reported. Descriptive statistics and Chi2-test analysis were performed.
Results
Results of the first 2 research phases are now available. Baseline data included patients with 155 DRFs and 135 AFs of which 364 radiographs were made during FU. For AF 86.3% of FU radiographs were routine, and for DRF 97% were. After classical DI, 30 AFs and 9 DRFs were included of which 39 radiographs were made (so far, updated results in May). For AF 56.7% were routine radiographs during FU and 44.4% for DRF. Chi2-testing showed a p-value of <0.0001. After classical DI, no routine radiograph led to a change in treatment strategy.
Conclusions
Preliminary results show a significant reduction in routine radiographs following classical de-implementation methods, without clinical consequences. Further results will be available at the ECTES congress in May.
References
1 van Gerven et al J Bone and Joint Surgery 2019
2 van Gerven et al J Bone and Joint Surgery 2020
3 van Gerven et al J Eval Clin Practice 2019
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This study was funded by ZonMw, The Netherlands Organization for Health Research and Development (project number 84300095007)