Dataset Information

Amsterdam wrist rules: a clinical decision aid.

ABSTRACT:

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.

SUBMITTER: Bentohami A

PROVIDER: S-EPMC3229467 | biostudies-literature | 2011 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Amsterdam wrist rules: a clinical decision aid.

Bentohami Abdelali A Walenkamp Monique M J MM Slaar Annelie A Beerekamp M Suzan H MS de Groot Joris A H JA Verhoog Eva M EM Jager L Cara LC Maas Mario M Bijlsma Taco S TS van Dijkman Bart A BA Schep Niels W L NW Goslings J Carel JC

BMC musculoskeletal disorders 20111017

<h4>Background</h4>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.<h4>Methods/design</h4>This study will be a multi-center observational diagnostic study in which the data will b ...[more]

PMID: 22004344

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Dataset Information

Amsterdam wrist rules: a clinical decision aid.

Background

Methods/design

Discussion

Trial registration

Publications

Amsterdam wrist rules: a clinical decision aid.

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