One of the Amsterdam wrist rules is for pediatric wrist trauma. This can help to reduce imaging studies in children. The authors are from the University of Amsterdam, Erasmus MC, and multiple hospitals in The Netherlands.
Patient selection: wrist trauma, age < 18 years
Parameters:
(1) age in years
(2) swelling of distal radius
(3) visible deformity present
(4) bone tenderness of distal radius
(5) bone tenderness of anatomical snuff box
(6) painful supination
Parameter
Finding
Points
age in years
-0.185 * (age)
swelling distal radius
no
0
yes
1.144
visible deformity
no
0
yes
1.56
bone tenderness distal radius
no
0
yes
1.183
bone tenderness of anatomical snuffbox
no
0
yes
-1.424
painful supination
no
0
yes
0.356
total score =
= SUM(points for all 6 parameters) + 0.466
probability of fracture =
= 1 / (1 + EXP((-1) * X))
Performance:
• The sensitivity was 96% and specificity 37%.
• There was a 22% reduction in X-ray exams.
• In the validation set 4% of fractures were missed.
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