462 - An audit to investigate whether sufficient justification for chest x-rays is given for an unaccounted tooth in dental trauma

F Hall A Holmes S Mustafa
Presented by: Frances Hall
Prince Charles Hospital

Introduction Dental trauma is a common presentation for the OMFS team in the Emergency Department (ED). An undetected aspirated tooth in dental trauma can lead to the development of severe complications such as a lung abscess, pneumonia, and even respiratory arrest. It is vital that clinicians understand indications for a chest x-ray when a tooth is unaccounted for. There are no current evidence-based guidelines for when to perform a chest x-ray for an unaccounted tooth. Methods From the literature search, it was generally well accepted that where there is an unaccounted tooth alongside a loss of consciousness at the time of injury or presence of respiratory symptoms, a chest x-ray would be indicated. Based on these results and expert clinician input, a preliminary guidance protocol was developed. The size of the unaccounted tooth fragment was also acknowledged in the guidance. Patient notes coded under ‘Dental Injury’ from January 2018 to December 2019 from ED were reviewed from the unit. Of these, 34 patients attended with dental trauma resulting in a tooth that was unaccounted for. The guidance protocol was used as the criteria to assess whether, retrospectively, chest x-rays were clinically justified. The standard was set at 100% as all medical exposure should be justifiable. Results Of the 34 cases of dental trauma resulting in an unaccounted tooth, 100% adhered to the preliminary guidance protocol. 21% (n=7) of the total cases had a chest x-ray performed. The chest x-rays did not have positive radiographic findings and thus no intervention was required. 6 of these 7 cases requested a chest x-ray without loss of consciousness or respiratory symptoms. Conclusion Implementation of the devised protocol would allow clinicians to objectively assess the need for radiographic imaging but also provides the flexibility to deviate from established guidelines on a patient to patient basis. This would mitigate both medical and medico-legal complications in the future.
Consent Statement: There are no details on individual patients reported within the abstract.

Poster