title: Selective radiography in 100 patients with suspected shoulder dislocation.
abstract: We sought to prospectively validate an algorithm for selective radiography in the Emergency Department (ED) management of patients with suspected shoulder dislocation. Physicians ordered pre- and post-reduction radiographs based on an algorithm incorporating the mechanism of injury, previous dislocations, and the physician's clinical certainty of joint position. Follow-up consisted of telephone calls and chart review. Of 100 patients, 94 had shoulder dislocation, and 59% were recurrent. Thirty percent had both pre- and post-reduction radiographs, 45% had pre- or post-reduction only, and 25% had no shoulder films, yielding an overall 46% reduction in X-ray utilization. Mean ED times were significantly shorter for patients managed without radiographs. On telephone follow-up (76%) and chart review (100%), we found no missed fractures or persistent dislocations. Use of a clinical decision rule for selective radiography reduced the number of radiographs and time spent in the ED, while missing no fractures or dislocations.
authors.affiliation: Department of Emergency Medicine, University of California San Francisco-Fresno, University Medical Center, Fresno, California 93702, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hendey
authors.forename: M Kristin
authors.initials: MK
authors.lastname: Chally
authors.forename: V Brooks
authors.initials: VB
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000465:Algorithms; D002983:Clinical Competence; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D011859:Radiography; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging*