The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decisionrule for the use of radiography in acute wrist trauma
Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/26682537
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4683697/
http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0829-2
De:
Walenkamp MM1, Bentohami A2, Slaar A3, Beerekamp MS4, Maas M5, Jager LC6, Sosef NL7, van Velde R8, Ultee JM9, Steyerberg EW10, Goslings JC11,Schep NW12.
BMC Musculoskelet Disord. 2015 Dec 18;16:389. doi: 10.1186/s12891-015-0829-2.
Todos los derechos reservados para:
TRIAL REGISTRATION:
This study was registered in the Dutch Trial Registry, reference number NTR2544 on October 1(st), 2010.
Un modelo de predicción clínica estima el riesgo de un cierto resultado. Una regla de decisión clínica recomienda una acción al riesgo previsto. En este estudio, la recomendación sería pedir o no una radiografía.
La regla de predicción clínica de muñeca de Amsterdan mostró una alta sensibilidad (98%) y un valor predictivo negativo (90%) para las fracturas de la muñeca. Hasta el momento no hay directrices o criterios disponibles. Las Reglas de muñeca de Amsterdam pueden proporcionar a los médicos de una herramienta de screening externo válida dentro del Servicio de Urgencias
La fórmula para las reglas de la muñeca de Amsterdam, prediciendo la probabilidad de una fractura, estará disponible en una aplicación de teléfono inteligente. Al entrar en las variables clínicas, la aplicación calculará la probabilidad de fractura y dará una recomendación (de indicar o no rayos X).
Las Reglas de muñeca de Amsterdam es una regla de predicción clínica con una alta sensibilidad y valor predictivo negativo para las fracturas de la muñeca. Las Reglas de muñeca Amsterdam pueden proporcionar a los médicos en el Servicio de Urgencias de una herramienta de evaluación útil para seleccionar a los pacientes con traumatismo de muñeca aguda para la radiografía.
> De: Walenkamp, BMC Musculoskeletal Disorders 16 (2016) 389. Todos los derechos reservados: The Author(s).Pincha aquí para acceder al resumen en Pubmed. Traducido por Vicente Mauri.
Abstract
BACKGROUND:
Although only 39 % of patients with wrist trauma have sustained a fracture, the majority of patients is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects patients with acute wrist trauma in the Emergency Department (ED) for radiography.
METHODS:
This multicenter prospective study consisted of three components: (1) derivation of a clinical prediction model for detecting wristfractures in patients following wrist trauma; (2) external validation of this model; and (3) design of a clinical decision rule. The study was conducted in the EDs of five Dutch hospitals: one academic hospital (derivation cohort) and four regional hospitals (external validation cohort). We included all adult patients with acute wrist trauma. The main outcome was fracture of the wrist (distal radius, distal ulna or carpal bones) diagnosed on conventional X-rays.
RESULTS:
A total of 882 patients were analyzed; 487 in the derivation cohort and 395 in the validation cohort. We derived a clinical prediction model with eight variables: age; sex, swelling of the wrist; swelling of the anatomical snuffbox, visible deformation; distal radius tender to palpation; pain on radial deviation and painful axial compression of the thumb. The Area Under the Curve at external validation of this model was 0.81 (95 % CI: 0.77-0.85). The sensitivity and specificity of the Amsterdam Wrist Rules (AWR) in the external validation cohort were 98 % (95 % CI: 95-99 %) and 21 % (95 % CI: 15 %-28). The negative predictive value was 90 % (95 % CI: 81-99 %).
CONCLUSIONS:
The Amsterdam Wrist Rules is a clinical prediction rule with a high sensitivity and negative predictive value for fractures of thewrist. Although external validation showed low specificity and 100 % sensitivity could not be achieved, the Amsterdam Wrist Rules can provide physicians in the Emergency Department with a useful screening tool to select patients with acute wrist trauma for radiography. The upcoming implementation study will further reveal the impact of the Amsterdam Wrist Rules on the anticipated reduction of X-rays requested, missed fractures, Emergency Department waiting times and health care costs.
TRIAL REGISTRATION:
This study was registered in the Dutch Trial Registry, reference number NTR2544 on October 1(st), 2010.
