Ordering X-Rays from Triage

Be specific

  • Subtle fractures are hard to pick up – especially if the wrong X-Ray is requested. Ordering the right X-Ray helps patients.
  • Finger injury – request X-Ray Finger(specific), NOT a hand (they are different views and often of little use)
  • Wrist injury – request X-Ray Wrist NOT Radius & Ulna
    • You can request they include the distal half of radius and ulna if the pain covers that area but still request a wrist

Keep X-rays to a minimum

It is unlikely that a patient with a minor injury has broken both their foot and ankle or humerus and wrist. It can happen but its rare. If you can’t identify the exact area of pain or seems over large areas it could be the soft tissue, analgesia and ENP review seems most appropriate. This is often the case in children as they can’t articulate there pain

Major X-rays

The larger the body part the greater the x-ray dose, thus hip/femur or chest x-rays require larger doses of x-ray. This is obviously appropriate for patients in majors on the NOF pathway. Patients walking in with femur/hip pain from a fall are less likely to have a fracture and chest x-rays give limited information about fractures and rarely change the management. As a rule these x-rays shouldn’t be requested from triage. Analgesia and ENP or Doctor Review would be best.

Don’t x-ray toes (except big toe)

Unless clinically deformed or open wound

The management of the smaller toes is not often changed by X-rays so there is often no clinical benefit, except when deformed or possibility of an open fracture.


Thanks  G for the good advice.

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