title: Sideline coverage: when to get radiographs? A review of clinical decision tools.
abstract: BACKGROUND
  Sidelines coverage presents unique challenges in the evaluation of injured athletes. Health care providers may be confronted with the question of when to obtain radiographs following an injury. Given that most sidelines coverage occurs outside the elite level, radiographs are not readily available at the time of injury, and the decision of when to send a player for radiographs must be made based on physical examination. Clinical tools have been developed to aid in identifying injuries that are likely to result in radiographically important fractures or dislocations.
  
  
  METHODS
  A search for the keywords x-ray and decision rule along with the anatomic locations shoulder, elbow, wrist, knee, and ankle was performed using the PubMed database. No limits were set regarding year of publication. We selected meta-analyses, randomized controlled trials, and survey results. Our selection focused on the largest, most well-studied published reports. We also attempted to include studies that reported the application of the rules to the field of sports medicine.
  
  
  METHODS
  Retrospective literature review.
  
  
  METHODS
  Level 4.
  
  
  RESULTS
  The Ottawa Foot and Ankle Rules have been validated and implemented and are appropriate for use in both pediatric and adult populations. The Ottawa Knee Rules have been widely studied, validated, and accepted for evaluation of knee injuries. There are promising studies of decision rules for clinically important fractures of the wrist, but these studies have not been validated. The elbow has been evaluated with good outcomes via the elbow extension test, which has been validated in both single and multicenter studies. Currently, there are no reliable clinical decision tools for traumatic sports injuries to the shoulder to aid in the decision of when to obtain radiographs.
  
  
  CONCLUSIONS
  Clinical decision tools have been developed to aid in the diagnosis and management of injuries commonly sustained during sporting events. Tools that have been appropriately validated in populations outside the initial study population can assist sports medicine physicians in the decision of when to get radiographs from the sidelines.
authors.affiliation: Regional Orthopedics, New York, New York ; Department of Emergency Medicine, NYU Langone Medical Center, New York, New York.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Gould
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York ; Center for Musculoskeletal Care, NYU Langone Medical Center, New York, New York.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Cardone
authors.affiliation: Department of Orthopedics Surgery, Maimonides Medical Center, Maimonides Bone & Joint Center, New York, New York.
authors.forename: John
authors.initials: J
authors.lastname: Munyak
authors.affiliation: Department of Emergency Medicine, Sports Medicine, North Shore-LIJ Health System, Manhasset, New York.
authors.forename: Philipp J
authors.initials: PJ
authors.lastname: Underwood
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Gould
keywords: clinical decision tools; extremity injury; radiographs; sidelines