The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist trauma

Walenkamp, Monique M. J.; Bentohami, Abdelali; Slaar, Annelie; Beerekamp, M. Suzan H.; Maas, Mario; Jäger, Luise; Sosef, Nico L.; Velde, Romuald van; Ultee, Jan M.; Goslings, J. Carel; Schep, N.W.L.

doi:10.1186/s12891-015-0829-2

Cited by 30 publications

(33 citation statements)

References 24 publications

(30 reference statements)

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“…This is possibly a result of the very low a priori probability for a fracture in ankle injuries of 14%, compared to 53% for wrist trauma [36, 37]. The higher probability limits the possibilities for improvement.…”

Section: Discussionmentioning

confidence: 99%

External validation of clinical decision rules for children with wrist trauma

et al. 2017

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BackgroundClinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs.ObjectiveThe primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients. Secondarily, we aimed to compare the performance of these rules with the validated Amsterdam Pediatric Wrist Rules.Materials and methodsWe included all studies that proposed a clinical prediction or decision rule in children presenting at the emergency department with acute wrist trauma. We performed external validation within a cohort of 379 children. We also calculated the sensitivity, specificity, negative predictive value and positive predictive value of each decision rule.ResultsWe included three clinical decision rules. The sensitivity and specificity of all clinical decision rules after external validation were between 94% and 99%, and 11% and 26%, respectively. After external validation 7% to 17% less radiographs would be ordered and 1.4% to 5.7% of all fractures would be missed. Compared to the Amsterdam Pediatric Wrist Rules only one of the three other rules had a higher sensitivity; however both the specificity and the reduction in requested radiographs were lower in the other three rules.ConclusionThe sensitivity of the three non-validated clinical decision rules is high. However the specificity and the reduction in number of requested radiographs are low. In contrast, the validated Amsterdam Pediatric Wrist Rules has an acceptable sensitivity and the greatest reduction in radiographs, at 22%, without missing any clinically relevant fractures.

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Section: Discussionmentioning

confidence: 99%

External validation of clinical decision rules for children with wrist trauma

et al. 2017

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“…The inclusion of all acute wrist injuries ensured that all scaphoid fractures were included in the analysis to get an accurate representation of clinical practice. The statistical models have been thoroughly tested, for this study as well as previously for the Amsterdam Wrist Rules [13,20].…”

Section: Discussionmentioning

confidence: 99%

“…This study was part of a comprehensive research project, the Amsterdam Wrist Rules. This study included all wrist injuries to identify predictors for a distal radius or a scaphoid fracture [20]. A prospective multicenter study was performed, consisting of three components: (1) derivation of a clinical prediction model for detecting scaphoid fractures in patients following wrist trauma; (2) internal validation via bootstrapping and (3) design of a clinical decision rule.…”

Section: Methodsmentioning

confidence: 99%

Detecting scaphoid fractures in wrist injury: a clinical decision rule

Mallee

Walenkamp

Mulders

et al. 2020

Arch Orthop Trauma Surg

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Introduction The aim of this study was to develop and validate an easy to use clinical decision rule, applicable in the ED that limits the number of unnecessary cast immobilizations and diagnostic follow-up in suspected scaphoid injury, without increasing the risk of missing fractures. Methods A prospective multicenter study was conducted that consisted of three components: (1) derivation of a clinical prediction model for detecting scaphoid fractures in adult patients following wrist trauma; (2) internal validation of the model;(3) design of a clinical decision rule. The predictors used were: sex, age, swelling of the anatomic snuffbox, tenderness in the anatomic snuffbox, scaphoid tubercle tenderness, painful ulnar deviation and painful axial thumb compression. The outcome measure was the presence of a scaphoid fracture, diagnosed on either initial radiographs or during re-evaluation after 1-2 weeks or on additional imaging (radiographs/MRI/CT). After multivariate logistic regression analysis and bootstrapping, the regression coefficient for each significant predictor was calculated. The effect of the rule was determined by calculating the number of missed scaphoid fractures and reduction of suspected fractures that required a cast. Results A consecutive series of 893 patients with acute wrist injury was included. Sixty-eight patients (7.6%) were diagnosed with a scaphoid fracture. The final prediction rule incorporated sex, swelling of the anatomic snuffbox, tenderness in the anatomic snuffbox, painful ulnar deviation and painful axial thumb compression. Internal validation of the prediction rule showed a sensitivity of 97% and a specificity of 20%. Using this rule, a 15% reduction in unnecessary immobilization and imaging could be achieved with a 50% decreased risk of missing a fracture compared with current clinical practice. Conclusions This dataset provided a simple clinical decision rule for scaphoid fractures following acute wrist injury that limits unnecessary immobilization and imaging with a decreased risk of missing a fracture compared to current clinical practice. Clinical prediction rule 1/(1 + EXP (−(0.649662618 × if man) + (0.51353467826 × if swelling anatomic snuffbox) + (−0.79038263985 × if painful palpation anatomic snuffbox) + (0.57681198857 × if painful ulnar deviation) + (0.66499549728 × if painful thumb compression)−1.685). Trial registration Trial register NTR 2544, www.trial regis ter.nl.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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“…All patients had a protocolized physical examination and a radiographic measurement of the wrist. 15 This database contains information about patients with and without fractures of the distal radius. For this retrospective observational study, consecutive adult patients with nonoperatively treated distal radius fractures (AO [Arbeitsgemeinschaft für Osteosynthesefragen] classification type A and C) and with unfractured wrists were included.…”

Section: Patient Selectionmentioning

confidence: 99%

Carpal Alignment: A New Method for Assessment

et al. 2018

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Background Carpal alignment may be used as a tool to evaluate fracture reduction in patients with distal radius fractures. However, there is little consensus on how to measure and quantify carpal alignment. Purpose The aim of this study was to compare the inter- and intraobserver variability of a new perpendicular method with the existing method in fractured and unfractured wrists. Additionally, the normal distribution of carpal alignment in unfractured wrists was investigated. Patients and Methods Carpal alignment was assessed on lateral plain radiographs using two different methods, one described by Ng and McQueen and another newly proposed method, the perpendicular method. Using the perpendicular method, the observer draws one line along the inner rim of the volar cortex of the radius and one perpendicular line to the center of the capitate. The carpus is aligned when the line along the inner rim transects the center of the capitate. Three examiners measured the carpal alignment in 50 patients with nonfractured and 50 patients with fractured distal radius. Intra- and interobserver variability for both methods were determined. Results The interobserver coefficient for the perpendicular method was 0.98 and that for the Ng method was 0.86. The intraobserver coefficients for three examiners were 0.89, 0.62, and 0.63, respectively, for the Ng method. For the perpendicular method, the intraobserver variability was 0.96, 0.89, and 0.72, respectively. In patients with unfractured wrists, the mean perpendicular to the center of the capitate was 0.25 mm dorsally. Conclusion The new proposed method is a reproducible method for measuring carpal alignment with a high inter- and intraclass coefficient. Clinical Relevance This method of measurement allows for a reproducible technique for measuring carpal alignment.

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The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist trauma

Cited by 30 publications

References 24 publications

External validation of clinical decision rules for children with wrist trauma

External validation of clinical decision rules for children with wrist trauma

Detecting scaphoid fractures in wrist injury: a clinical decision rule

Carpal Alignment: A New Method for Assessment

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