A validation study for a clinical decision rule for acute wrist injury
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ORIGINAL ARTICLE
A validation study for a clinical decision rule for acute wrist injury Anne Brants1 · Berwout van der Woude1 · Michiel IJsseldijk2 · Dan Thao Vy3 · René Verbeek4 Received: 9 May 2020 / Accepted: 21 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 55 years > 60 years Gender Male vs. female Setting of injury Fall onto an outstretched hand Sports injury Road traffic accident Other Patient history Loss of function Support needed for pain relief Direct swelling of the wrist Physical examination Swelling and/or hematoma Swelling Hematoma Visible wrist deformity Tenderness on palpation Distal radius Distal ulna Anatomic snuff box/scaphoid Other carpal bones Decreased range of motion Reduced range of motion (any) Pronation Supination Dorsal flexion Palmar flexion Radial deviation Ulnar deviation
χ2-test (95% CI)
Table 4 The association between clinical variables and presence of a fracture (N = 493) for 724 injuries
p
4.91 (3.51–6.87) 4.20 (3.01–5.85) 3.08 (2.20–4.31)
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