A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist RulesReport as inadecuate




A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules - Download this document for free, or read online. Document in PDF available to download.

Pediatric Radiology

, Volume 46, Issue 1, pp 50–60

First Online: 23 August 2015Received: 16 February 2015Revised: 26 May 2015Accepted: 09 July 2015DOI: 10.1007-s00247-015-3436-3

Cite this article as: Slaar, A., Walenkamp, M.M.J., Bentohami, A. et al. Pediatr Radiol 2016 46: 50. doi:10.1007-s00247-015-3436-3

Abstract

BackgroundIn most hospitals, children with acute wrist trauma are routinely referred for radiography.

ObjectiveTo develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required.

Materials and methodsWe prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography.

ResultsIncluded in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 95% CI: 0.76-0.83. The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7-170 fractures 4.1%, 95% CI: 1.7-8.3% would have been missed using the decision model.

ConclusionThe decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required.

KeywordsChild Clinical decision rule Distal forearm fracture Multicenter prospective study design Radiography Trauma Wrist  Download fulltext PDF



Author: Annelie Slaar - Monique M. J. Walenkamp - Abdelali Bentohami - Mario Maas - Rick R. van Rijn - Ewout W. Steyerberg - L.

Source: https://link.springer.com/



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