A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules

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• 作者：Yunus Karaca ; MD<sup>asup> ; Suha Turkmen ; MD<sup>asup><sup> ; sup><sup>drsuhaturkmen@hotmail.com" class="auth_mail" title="E-mail the corresponding authorsup> ; Aysegul Cansu ; MD<sup>bsup> ; Mehmet Emre Baki ; MD<sup>csup> ; Oguz Eroglu ; MD<sup>dsup> ; Ozgur Tatli ; MD<sup>asup> ; Mucahit Gunaydin ; MD<sup>esup> ; Ercument Beyhun ; MD<sup>fsup> ; Abdulkadir Gunduz ; MD<sup>asup> ; Umut Eryiğit ; MD<sup>asup> ; Ahmet Baydın ; MD<sup>gsup> ; Murat Gü ; zel ; MD<sup>hsup> ; Faruk Ö ; zşahin ; MD<sup>isup> ; Ö ; zlem Bilir ; MD<sup>jsup> ; Aynur Şahin ; MD<sup>asup> ; Veyis Taşın ; MD<sup>ksup> ; Aslan Kalay ; MD<sup>lsup> ; Orkun Gü ; l ; MD<sup>csup> ; Suleyman Turedi ; MD<sup>asup>
• 刊名：The American Journal of Emergency Medicine
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：34
• 期：11
• 页码：2074-2078
• 全文大小：275 K

文摘

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.

sSec_2">Methods

sp0030">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.

sSec_3">Results

sp0035">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%.

sSec_4">Conclusion

sp0040">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.