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Am J Emerg Med. 2015 Sep;33(9):1269-72. doi: 10.1016/j.ajem.2015.06.011. Epub 2015 Jun 12.

Determination of radiography requirement in wrist trauma.

Author information

1
Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey. Electronic address: drsuhaturkmen@hotmail.com.
2
Karadeniz Technical University, Faculty of Medicine, Department of Radiology, Trabzon, Turkey.
3
Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
4
Karadeniz Technical University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Trabzon, Turkey.
5
Kırıkkale University, Faculty of Medicine, Department of Emergency Medicine, Kırıkkale, Turkey.
6
Kanuni Training and Research Hospital, Department of Emergency Medicine, Trabzon, Turkey.
7
Giresun University, Faculty of Medicine, Department of Emergency Medicine, Giresun, Turkey.
8
Karadeniz Technical University, Faculty of Medicine, Department of Public Health, Trabzon, Turkey.

Abstract

OBJECTIVES:

The purpose of this study was to evaluate predetermined physical examination and function tests recommended to identify severe injury among patients presenting with wrist injury to the emergency department and to establish a reliable clinical decision rule capable of determining the need for radiography in wrist injuries.

MATERIALS AND METHODS:

This was a multicenter prospective derivation study of wrist injuries. All patients were assessed in terms of mechanism of trauma, inspection findings, heart rate, sensitivity at palpation, presence of pain with active movement, grasp strength, and functional tests using an examination form under main headings. Sensitivity, specificity, and positive and negative predictive values were expressed for each sign and each examination finding.

RESULTS:

One hundred nineteen adult patients were enrolled during the 6-month study period. Fracture was identified in 24.3% (n = 29). Presence of pain on the radial deviation, dorsal flexion, distal radioulnar drawer, and axial compression tests exhibited high sensitivity (82.8%, 89.7%, 82.8%, and 86.2%, respectively) and high negative predictive values (88.6%, 81.3%, 87.5%, and 93.6%, respectively) for wrist fracture. Sensitivity of 96.6% was observed when these 4 tests were evaluated together.

CONCLUSIONS:

The presence of one of these examination findings increases the likelihood of fracture and is adequate to recommend wrist radiography. In addition, there is a strong possibility of radiography being unnecessary if all 4 test results are negative in patients presenting with wrist injury, potentially preventing many nonessential radiographs being performed.

PMID:
26113244
DOI:
10.1016/j.ajem.2015.06.011
[Indexed for MEDLINE]

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