Amsterdam wrist rules: A clinical decision aid

BMC Musculoskeletal Disorders

J C Goslings⁴  Niels WL Schep⁴  Bart A van Dijkman²  Taco S Bijlsma⁶  Mario Maas⁵  L Cara Jager³  Eva M Verhoog³  Joris AH de Groot¹  M Suzan H Beerekamp⁴  Annelie Slaar⁵  Monique MJ Walenkamp⁴  Abdelali Bentohami⁴ 

[1] Department of Clinical Epidemiology, University Medical Center, Utrecht, Huispost Str. 6.131, P.O. BOX 85500, 3508 GA Utrecht The Netherlands;Department of Surgery-Traumatology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands;Department of Emergency Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands;Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands;Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands;Department of Surgery-Traumatology, Spaarne Hospital, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands

关键词: Wrist Injury;    Validation Study;    Trauma Surgery;    Surgery;    Radiography;    Distal Radius Fractures;    Diagnosis;    Decision Rule;    Clinical Decision Rule;   

Others  :  1151698
DOI  :  10.1186/1471-2474-12-238

 received in 2011-03-16, accepted in 2011-10-17,  发布年份 2011

【 摘 要 】

Background

Acute trauma of the wrist is one of the most frequent reasons for visiting the Emergency Department. These patients are routinely referred for radiological examination. Most X-rays however, do not reveal any fractures. A clinical decision rule determining the need for X-rays in patients with acute wrist trauma may help to percolate and select patients with fractures.

Methods/Design

This study will be a multi-center observational diagnostic study in which the data will be collected cross-sectionally. The study population will consist of all consecutive adult patients (≥18 years) presenting with acute wrist trauma at the Emergency Department in the participating hospitals.

This research comprises two components: one study will be conducted to determine which clinical parameters are predictive for the presence of a distal radius fracture in adult patients presenting to the Emergency Department following acute wrist trauma. These clinical parameters are defined by trauma-mechanism, physical examination, and functional testing. This data will be collected in two of the three participating hospitals and will be assessed by using logistic regression modelling to estimate the regression coefficients after which a reduced model will be created by means of a log likelihood ratio test. The accuracy of the model will be estimated by a goodness of fit test and an ROC curve. The final model will be validated internally through bootstrapping and by shrinking it, an adjusted model will be generated.

In the second component of this study, the developed prediction model will be validated in a new dataset consisting of a population of patients from the third hospital. If necessary, the model will be calibrated using the data from the validation study.

Discussion

Wrist trauma is frequently encountered at the Emergency Department. However, to this date, no decision rule regarding this type of trauma has been created. Ideally, radiographs are obtained of all patients entering one of the participating hospitals with trauma to the wrist. However, this is ethically and logistically not feasible and one could argue that patients, for whom no radiography is required according to their physician, are not suspected of having a distal radius fracture and thus are not part of the domain.

Trial registration

This study is registered at the Netherlands Trial Register (NTR 2544) and was granted permission by the Medical Ethical Committee of the Academic Medical Center Amsterdam on 06-01-2011.

【 授权许可】

   
2011 Bentohami et al; licensee BioMed Central Ltd.

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