title: Predictors of Clinically Significant Radiographic Shoulder Pathology in the Emergency Department.
abstract: BACKGROUND
  Although there are no clinical decision rules for radiograph use among persons with shoulder pain, they are ordered for most patients. Previously published reviews have demonstrated that radiography is overutilized in evaluating emergency department (ED) patients with shoulder pain, and clinical factors might define patients in whom plain film radiography need not be performed.
  
  
  OBJECTIVE
  The objectives of this study were to identify predictors of clinically significant shoulder pain and develop a clinical decision radiograph-ordering rule for adult ED patients with shoulder pain.
  
  
  METHODS
  Records from adult ED visits resulting in shoulder radiographs were reviewed. Potential predictors of clinically significant shoulder pain were then identified. Univariate screening was performed to find variables associated with injury and were subsequently included in a multivariable prediction model.
  
  
  RESULTS
  Five of the predetermined factors were found to be associated with the likelihood of injury: history of trauma, range of motion, deformity, age, and duration of pain. Receiver operating characteristics revealed an area under the curve of 80%.
  
  
  CONCLUSIONS
  Despite accounting for multiple variables, the area under the curve was 80%. Based on these results it is not practical to develop clinical decision radiograph ordering rules for ED patients with shoulder pain.
authors.affiliation: Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Barry
authors.initials: B
authors.lastname: Hahn
authors.affiliation: Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Elias
authors.initials: E
authors.lastname: Youssef
authors.affiliation: Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Sunil
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Scibilia
authors.affiliation: Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York.
authors.forename: Martin
authors.initials: M
authors.lastname: Lesser
mesh_terms: D000328:Adult; D019540:Area Under Curve; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011859:Radiography; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging*; D012784:Shoulder Fractures / Q000000981:diagnostic imaging*; D000070599:Shoulder Injuries; D020069:Shoulder Pain / Q000000981:diagnostic imaging*
keywords: clinical decision rules; fracture; radiation; radiographs; radiology; shoulder