Determination of radiography requirement in wrist trauma

Turkmen, Süha; Cansu, Ayşegül; Karaca, Yunus; Baki, Mehmet Emre; Eroğlu, Oğuz; Tatlı, Özgür; Günaydın, Mücahit; Beyhun, Ercüment; Gunduz, Abdülkadir; Türedi, Süleyman

doi:10.1016/j.ajem.2015.06.011

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Currently, no clinical guidelines exist to endorse decision making regarding this radiograph referral. This may result in unnecessary radiographs and increased time spent at the ED, increased workload, and additional healthcare costs [4][5][6][7]. A thorough history and physical examination is important and may provide guidance in the decision to request a radiograph.…”

Section: Introductionmentioning

confidence: 99%

“…A thorough history and physical examination is important and may provide guidance in the decision to request a radiograph. The value of physical examination findings as predictors for wrist fractures has previously been studied [7][8][9]. However, these studies were limited by small study populations and did not propose a clinical decision rule.…”

Section: Introductionmentioning

confidence: 99%

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The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

Mulders

Walenkamp

Sosef

et al. 2019

Eur J Trauma Emerg Surg

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Purpose While most patients with wrist trauma are routinely referred for radiography, around 50% of these radiographs show no fracture. To avoid unnecessary radiographs, the Amsterdam Wrist Rules (AWR) have previously been developed and validated. The aim of the current study was to evaluate the effect of the implementation of the AWR at the Emergency Department (ED). Methods In a before-and-after comparative prospective cohort study, all consecutive adult patients with acute wrist trauma presenting at the ED of four hospitals were included. Primary outcome was the number of wrist radiographs before and after implementation of the AWR. Secondary outcomes were the number of clinically relevant missed fractures, the overall length of stay in the ED, physician compliance regarding the AWR, and patient satisfaction and experience with the care received at the ED. Results A total of 402 patients were included. The absolute reduction in wrist radiographs after implementation was 15% (p < 0.001). One clinically irrelevant fracture was missed. Non-fracture patients without wrist radiography due to the AWR spent 34 min less time in the ED compared with non-fracture patients who had a wrist radiograph (p = 0.015). The physicians adhered to the AWR in 36% of patients. Of all patients who did not receive a radiographic examination of the wrist, 87% were satisfied. Conclusion Implementation of the AWR safely reduces the amount of wrist radiographs in selected patients and consequently reducing the length of stay in the ED.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

Mulders

Walenkamp

Sosef

et al. 2019

Eur J Trauma Emerg Surg

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“…y CT in minor or single-system trauma CW, NICE [25 172 184-187] r CT in pediatric trauma for injuries that the facility does not have to treat [6 188-191] r repeat CT in transferred trauma patient with imaging performed l center, no disease progression or additional details needed[88 192y in pediatric minor head injury, negative on a validated clinical le (e.g. C3PO)[ 124 197-199] y in blunt trauma, hemodynamically stable with normal physical 00 -205] y in adult wrist injury with normal physical exam [206] y in pediatric wrist injury, >2 years of age and normal physical 08] ay in blunt trauma, stable with negative physical exam for pelvic Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.…”

Section: A C C E P T E Dmentioning

confidence: 99%

Low-value clinical practices in injury care: A scoping review and expert consultation survey

Moore

Lauzier

Tardif

et al. 2019

J Trauma Acute Care Surg

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“…Results showing that x-ray is not necessary in every case of wrist trauma in recent studies revealed a need for procedures to be followed in elbow trauma. [5][6][7][8][9][10][11] Some studies intended to identify those patients for whom x-ray should be requested have reported that extension tests at physical examination may be sufficient, [9] while the most recent studies have shown that the elbow extension test and fracture point tenderness test cannot by themselves exclude elbow injury. [12] The purpose of this study was to perform various tests measuring elbow joint functions in patients presenting to the emergency department with acute elbow trauma and to identify those patients in whom fractures may be present in the light of the data obtained.…”

Section: Introductionmentioning

confidence: 99%

Dirsek Travmasında Fizik Muayene Bulguları ile Radyografi Gerekliliğinin Belirlenmesi

Günaydın

ÖZER

Karaca

et al. 2022

Journal of Contemporary Medicine

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The purpose of this study was to estimate the presence of fracture and to determine radiography requirements through results obtained by evaluating the physical examination findings in elbow injury. Material and Method:This was a single center prospective study. All patients were evaluated in terms of trauma mechanism, inspection findings, presence of pain at palpation, pain with active movement, circulatory examination and loss of sensation. Sensitivity, specificity, positive and negative predictive value (NPV) were determined for each sign and each examination finding. Results:The study was performed with 47 patients. Fracture was determined in 10 patients (21.2%). Presence of pain at the elbow extansion, forearm supination (FS), medial epicondyle (ME) palpation and forearm pronation tests exhibited high sensitivity (100%, 100%, 90%, and 80%, respectively) and high NPV (100%, 95%, 96.4%, and 91%, respectively) for elbow fracture. These four tests produced significant p values (0.088, 0.012, 0.001, and 0.079, respectively) in elbow fractures. Combining the pain at FS and ME palpation tests exhibited 90% sensitivity, and 96.7% NPV. Conclusions:Positivity on any one of the four tests employed increases the probability of fracture and is sufficient for elbow radiography to be recommended in patients presenting due to elbow injury. However, radiography may not be required if combined FS and ME palpation test findings are negative in this patients.

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Determination of radiography requirement in wrist trauma

Cited by 5 publications

References 7 publications

The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

Low-value clinical practices in injury care: A scoping review and expert consultation survey

Dirsek Travmasında Fizik Muayene Bulguları ile Radyografi Gerekliliğinin Belirlenmesi

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