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

Autor: L. Cara Jager, Annelie Slaar, Niels W. L. Schep, Romuald van Velde, Rick R. van Rijn, Mario Maas, Nico L. Sosef, Jan M. Ultee, Ewout W. Steyerberg, J. Carel Goslings, Abdelali Bentohami, Monique M. J. Walenkamp
Přispěvatelé: Public Health, Other departments, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AMS - Amsterdam Movement Sciences, Radiology and Nuclear Medicine, Other Research, Surgery
Rok vydání: 2015
Předmět:
Male
Radiography
Wrist
Pediatrics
0302 clinical medicine
030212 general & internal medicine
Child
Netherlands
Neuroradiology
030222 orthopedics
Distal forearm fracture
Wrist Injuries
medicine.anatomical_structure
Plain radiography
Radiology Nuclear Medicine and imaging
Child
Preschool
Acute Disease
Practice Guidelines as Topic
Radiographic Image Interpretation
Computer-Assisted
Female
Original Article
Algorithms
musculoskeletal diseases
medicine.medical_specialty
Clinical Decision-Making
Sensitivity and Specificity
Trauma
Wrist injury
Decision Support Techniques
03 medical and health sciences
medicine
Humans
Radiology
Nuclear Medicine and imaging
Pediatrics
Perinatology
and Child Health
Multicenter prospective study design
Clinical decision
business.industry
Clinical decision rule
Infant
Newborn
External validation
Infant
Reproducibility of Results
Surgery
body regions
Pediatrics
Perinatology and Child Health
Physical therapy
Radius Fractures
business
Zdroj: Pediatric Radiology, 46(1), 50-60. Springer-Verlag
Pediatric Radiology
Pediatric radiology, 46(1), 50-60. Springer Verlag
ISSN: 1432-1998
0301-0449
Popis: Background In most hospitals, children with acute wrist trauma are routinely referred for radiography. Objective To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. Materials and methods We 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. Results Included 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. Conclusion The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required.
Databáze: OpenAIRE
Externí odkaz: