A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules - 22/07/16

Doi : 10.1016/j.ajem.2016.07.013

Yunus Karaca, MD ^a, Suha Turkmen, MD ^a,^{^⁎} , Aysegul Cansu, MD ^b, Mehmet Emre Baki, MD ^c, Oguz Eroglu, MD ^d, Ozgur Tatli, MD ^a, Mucahit Gunaydin, MD ^e, Ercument Beyhun, MD ^f, Abdulkadir Gunduz, MD ^a, Umut Eryiğit, MD ^a, Ahmet Baydın, MD ^g, Murat Güzel, MD ^h, Faruk Özşahin, MD ⁱ, Özlem Bilir, MD ^j, Aynur Şahin, MD ^a, Veyis Taşın, MD ^k, Aslan Kalay, MD ^l, Orkun Gül, MD ^c, Suleyman Turedi, MD ^a
^a Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
^b Karadeniz Technical University, Faculty of Medicine, Department of Radiology, Trabzon, Turkey
^c Karadeniz Technical University, Faculty of Medicine, Department of Orthopaedic Surgery, Trabzon, Turkey
^d Kırıkkale University, Faculty of Medicine, Department of Emergency Medicine, Kırıkkale, Turkey
^e Giresun University, Faculty of Medicine, Department of Emergency Medicine, Giresun, Turkey
^f Karadeniz Technical University, Faculty of Medicine, Department of Public Health, Trabzon, Turkey
^g Ondokuz Mayıs University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey
^h Samsun Training and Research Hospital, Department of Emergency Medicine, Samsun, Turkey
ⁱ Giresun State Hospital, Department of Emergency Medicine, Giresun, Turkey
^j Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Emergency Medicine, Rize, Turkey
^k Gümüshane State Hospital, Department of Emergency Medicine, Gümüshane, Turkey
^l Trabzon Fatih State Hospital, Department of Emergency Medicine, Trabzon, Turkey

^⁎Corresponding author at: Karadeniz Teknik Universitesi, Tip Fakultesi Acil Tip AD, 61080, Trabzon, Turkey.Karadeniz Teknik UniversitesiTip Fakultesi Acil Tip ADTrabzon61080Turkey

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 22 July 2016
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Introduction

The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma.

Methods

This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture.

Results

A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%.

Conclusion

With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.

Le texte complet de cet article est disponible en PDF.