Does Contralateral Elbow Radiography Improve Diagnostic Accuracy of Paediatric Elbow Fractures amongst Emergency Residents?

Background

Paediatric elbow fractures are difficult to diagnose because secondary ossification centres can obscure radiographic interpretation. Emergency physicians often request contralateral elbow radiographs to improve diagnostic accuracy, although the benefit of this practice remains controversial. This study aimed to evaluate the impact of contralateral elbow radiographs and a targeted educational intervention on the diagnostic accuracy of emergency residents interpreting paediatric elbow fractures.

Methods

This diagnostic study included 28 emergency residents at a tertiary hospital. Participants interpreted 23 paediatric elbow radiographic sets under 4 conditions: injured elbow only, injured plus contralateral elbow and the same evaluations after a targeted educational lecture. Diagnostic accuracy, sensitivity, specificity and confidence were analysed using paired statistical tests and regression models.

Results

Mean diagnostic accuracy improved significantly after the educational lecture (median score increased from 14 to 17; p < 0.001). The addition of contralateral elbow radiographs did not significantly improve diagnostic accuracy or confidence either before or after the educational intervention. Regression analysis identified targeted education as the strongest predictor of improved diagnostic performance.

Conclusions

Targeted educational interventions significantly enhance diagnostic accuracy in paediatric elbow fractures. The addition of contralateral elbow radiographs did not improve diagnostic performance in this controlled assessment setting. However, their selective use in specific clinical scenarios may still be beneficial, and clinical judgement remains essential. Level of Evidence: Level II (Diagnostic).