Abstract
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.
Highlights
In children, distal radius fractures comprise 25–36% of all fractures [1, 2] and are the most common fractures in children [3]
Slaar et al [9] showed that 51% of 1,233 children with a trauma of the wrist who presented at the emergency department of three Dutch hospitals had sustained a wrist fracture
After title and abstract screening and full-text reading, four articles met all our inclusion criteria (Fig. 1). One of these studies was the previously validated Amsterdam Pediatric Wrist Rules study [19]. This resulted in three other decision rules for children with wrist trauma
Summary
Distal radius fractures comprise 25–36% of all fractures [1, 2] and are the most common fractures in children [3]. The incidence of distal forearm fractures has shown a significant increase over the last few decades, from 151 in Sweden and 309 in the USA per 100,000 person-years to respectively 240 and 409 per 100,000 person-years [1, 5]. This is accompanied by an increasing number of emergency department visits and requested radiographs, and rising health care costs [1, 6, 7]. Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
