Emond et al identified predictors for fracture in patients with an anterior dislocation. These can help to identify a patient who may not need imaging studies. The authors are from Laval University in Quebec City.
Patient selection: anterior dislocation of the shoulder
Predictors of fracture:
(1) age >= 40 years (OR 5.2)
(2) first episode of dislocation (OR 4.2)
(3) mechanism of injury (OR 4.1)
Mechanisms of injury:
(1) fall greater than 1 flight of stairs
(2) fight or assault
(3) motor vehicle accident
The presence of any one of the predictors has a low specificity (0.23) but high sensitivity (0.98) giving a negative predictive value of 0.97.
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