Don’t order advanced imaging studies (MRI or CT) for most musculoskeletal conditions in a child until all appropriate clinical, laboratory, and plain radiographic examinations have been completed.
|Rationale and Comments:||History, physical examination, and appropriate radiographs remain the primary diagnostic modalities in pediatric orthopedics, as they are both diagnostic and prognostic for the great majority of pediatric musculoskeletal conditions. Examples of such conditions would include, but not be limited to, the workup of injury or pain (spine, knees, and ankles), possible infection, and deformity. MRI examinations and other advanced imaging studies are costly, frequently require sedation in the young child (five years old or less), and may not result in appropriate interpretation if clinical correlations cannot be made. Many conditions require specific MRI sequences or protocols best ordered by the specialist who will be treating the patient. Inappropriately obtained MRIs may need to be repeated in those circumstances. Additionally, a significant dose of radiation is delivered to the patient during a CT scan, so their utility in a specific case would be best confirmed prior to ordering. Therefore, in those conditions where advanced imaging is indicated, it has greater value when it is used to answer a specific question that arises from a thorough clinical and appropriate radiographic evaluation. Additionally, if you believe findings warrant additional advanced imaging, discuss with the consulting orthopedic surgeon to make sure the optimal studies are ordered.|
|References:||• Piccolo CL, Galluzzo M, Ianniello S, Trinci M, Russo A, Rossi E, Zecconlini M, Laporta A, Guglielmi G, Muiele V. Pediatric musculoskeletal injuries: role of ultrasound and magnetic resonance imaging. Mesculoskelet Surg. 2017;101(suppl 1):85-102.
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