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A validation study for a clinical decision rule for acute wrist injury

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Acute wrist injury is a common reason for visiting the emergency department. To date, there are no implemented clinical decision rules to predict a fracture in this group of patients. We previously identified six clinical predictors in adult patients with acute wrist trauma. The aim of this study was to validate these predictors as a decision rule in a validation cohort.

Methods

This prospective cohort study was conducted in the emergency department at five hospitals in the Netherlands and included adults with acute wrist injury. All collaborating physicians performed a standardized physical examination and data were collected in a case report form. The main outcome was defined as the radiographic presence of a wrist fracture. Six clinical variables that were significantly associated with a fracture (ρ < 0.01) were included in a model to develop the clinical decision rule.

Results

A total of 493 fractures in 724 patients were identified by radiographic assessment. Almost all of the clinical variables were associated with the presence of a fracture. Our decision rule had a sensitivity of 0.97 (95% CI 0.96–0.99) with a specificity of 0.26 (95% CI 0.20–0.32) in this validation cohort. Application of the decision rule resulted in a reduction in radiographic assessment rate of 10% at the cost of missing 2% of the fractures.

Conclusion

The decision rule showed a high sensitivity and low specificity, possible due to the high pre-test probability of a wrist fracture in the cohort. Our study needs further validation in other populations.

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Abbreviations

CRF:

Case report Form

CI:

Confidence Interval

ED:

Emergency department

SPSS:

Statistical Package for Social Statistics

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Acknowledgements

We would like to express our great appreciation to our colleagues Wouter Jetten, Kim van den Broek, Dennis Barten and Maudi Kuijs, who were part of the local research teams and greatly assisted the research. Our special thanks are extended to the staff of the emergency department of the participating hospitals: CWZ, Venlo, Drachten, Boxmeer and Goes. The collection of data by the emergency physicians and residents was greatly appreciated.

Funding

No funding or financial support was received.

Author information

Authors and Affiliations

  1. Emergency Department, Canisius-Wilhelmina Ziekenhuis, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands

    Anne Brants & Berwout van der Woude

  2. Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Michiel IJsseldijk

  3. Emergency Department, VieCuri Medisch Centrum, Tegelseweg 210, 5912 BL, Venlo, The Netherlands

    Dan Thao Vy

  4. Emergency Department, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN, Drachten, The Netherlands

    René Verbeek

Authors
  1. Anne Brants
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  2. Berwout van der Woude
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  3. Michiel IJsseldijk
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  4. Dan Thao Vy
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  5. René Verbeek
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Corresponding authors

Correspondence to Anne Brants or Berwout van der Woude.

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All authors declare no conflict of interest.

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Brants, A., van der Woude, B., IJsseldijk, M. et al. A validation study for a clinical decision rule for acute wrist injury. Eur J Trauma Emerg Surg 48, 4319–4325 (2022). https://doi.org/10.1007/s00068-020-01474-2

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  • DOI: https://doi.org/10.1007/s00068-020-01474-2

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