title: A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.
abstract: BACKGROUND
  The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma.
  
  
  METHODS
  This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture.
  
  
  RESULTS
  A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%.
  
  
  CONCLUSIONS
  With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Karaca
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey. Electronic address: drsuhaturkmen@hotmail.com.
authors.forename: Suha
authors.initials: S
authors.lastname: Turkmen
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Radiology, Trabzon, Turkey.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Cansu
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Orthopaedic Surgery, Trabzon, Turkey.
authors.forename: Mehmet Emre
authors.initials: ME
authors.lastname: Baki
authors.affiliation: Kırıkkale University, Faculty of Medicine, Department of Emergency Medicine, Kırıkkale, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Eroglu
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tatli
authors.affiliation: Giresun University, Faculty of Medicine, Department of Emergency Medicine, Giresun, Turkey.
authors.forename: Mucahit
authors.initials: M
authors.lastname: Gunaydin
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Public Health, Trabzon, Turkey.
authors.forename: Ercument
authors.initials: E
authors.lastname: Beyhun
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Gunduz
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Eryiğit
authors.affiliation: Ondokuz Mayıs University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Baydın
authors.affiliation: Samsun Training and Research Hospital, Department of Emergency Medicine, Samsun, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Güzel
authors.affiliation: Giresun State Hospital, Department of Emergency Medicine, Giresun, Turkey.
authors.forename: Faruk
authors.initials: F
authors.lastname: Özşahin
authors.affiliation: Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Emergency Medicine, Rize, Turkey.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Bilir
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Aynur
authors.initials: A
authors.lastname: Şahin
authors.affiliation: Gümüshane State Hospital, Department of Emergency Medicine, Gümüshane, Turkey.
authors.forename: Veyis
authors.initials: V
authors.lastname: Taşın
authors.affiliation: Trabzon Fatih State Hospital, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Aslan
authors.initials: A
authors.lastname: Kalay
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Orthopaedic Surgery, Trabzon, Turkey.
authors.forename: Orkun
authors.initials: O
authors.lastname: Gül
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Turedi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D010173:Palpation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D016059:Range of Motion, Articular; D014458:Ulna Fractures / Q000000981:diagnostic imaging*; D014954:Wrist Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult