title: Is there a need for a clinical decision rule in blunt wrist trauma?
abstract: BACKGROUND
  Blunt wrist trauma is a very common injury in emergency medicine. However, in contrast to other extremity trauma, there is no clinical decision rule for radiography in patients with blunt wrist trauma.
  
  
  OBJECTIVE
  The purpose of this study is to describe current practice and to assess the need and feasibility for a clinical decision rule for radiography in patients with blunt wrist trauma.
  
  
  METHODS
  All patients with blunt wrist trauma who presented to our Emergency Department (ED) during a 6-month period were included in this study. Basic demographics were analysed and the radiography ratio was determined. The radiography results were compared for different demographic groups. Current practice and the need and feasibility for a decision rule were evaluated using Stiell's checklist for clinical decision rules.
  
  
  RESULTS
  A total of 1019 patients with 1032 blunt wrist injuries presented at our ED in a period of 6 months. In 91.4% of patients, radiographs were taken. In 41.6% of those radiographed, a fracture was visible on plain radiography. Fractures were most common in the paediatric and senior age groups. However, even in the lower-risk groups we observed a fracture incidence of about 20%.
  
  
  CONCLUSIONS
  There is no need for a clinical decision rule for radiography in patients with blunt wrist trauma because the fracture ratio is high. Neither does it seem feasible to develop a highly sensitive and efficient decision rule. Therefore, the authors recommend radiography in all patients with blunt wrist trauma presenting to the ED.
authors.affiliation: Department of Emergency Medicine, Medical Center Haaglanden, The Hague, The Netherlands. Electronic address: c.vandenbrand@mchaaglanden.nl.
authors.forename: Crispijn L
authors.initials: CL
authors.lastname: van den Brand
authors.forename: Roderick H
authors.initials: RH
authors.lastname: van Leerdam
authors.forename: Jet H M E Quarles
authors.initials: JH
authors.lastname: van Ufford
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Rhemrev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D014954:Wrist Injuries / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Algorithm; Emergency medicine; Fractures; Radiography; Radius fractures; Wrist