Diagnostic test performance of Amsterdam wrist rules in diagnosing wrist fracture in adults with wrist trauma

Melika  Hajiaghaei Shahir; Parham Maroufi; Seyed Pouya Paknezhad; Seyed Ehsan Mousavi; Gholamreza  Faridaalaee

doi:10.18502/fem.v8i1.14894

Melika Hajiaghaei Shahir Tabriz Student Research committee, Tabriz university of medical sciences, Tabriz, Iran.
Parham Maroufi Department of Orthopedy, school of medicine, Tabriz university of medical sciences, Tabriz, Iran.
Seyed Pouya Paknezhad Emergency and Trauma Research Center, Tabriz university of medical sciences, Tabriz, Iran.
Seyed Ehsan Mousavi Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Gholamreza Faridaalaee Emergency and Trauma Research Center, Tabriz university of medical sciences, Tabriz, Iran.

DOI: https://doi.org/10.18502/fem.v8i1.14894

Keywords: Amsterdam Wrist Rule; Decision Rule; Wrist Fractures; X-ray

Abstract

Abstract:

Objective: Wrist trauma is a common chief complaint in emergency departments and radiography is used to make the diagnosis. Excessive usage of radiographs would utilize resources, exert risk of radiation exposure, and overcrowding. Amsterdam wrist rules (AWR) have been proposed as a tool for clinical decision-making regarding the need for wrist fracture diagnosis. This study assessed the diagnostic test performance of this rule in wrist trauma for wrist fracture.

Methods: All patients over 18 years old with the chief complaint of acute wrist trauma were included. They were excluded if Glascow coma scale (GCS) was below 15, needed emergency surgery without an X-ray, and had a history of wrist fracture in the past 3 months. Anteroposterior and lateral radiographs were obtained and the AWR predictors were assessed before going to the radiology unit. The presence of a fracture of the distal radius was confirmed by treating emergency physician or radiologist.

Results: 205 participants were recruited in this study, of which 6 patients (2.9%) were excluded due to missing data. The median age was 40 (IQR: 30-50) and 74 (37.2%) patients were female. There were 66 (33.2%) patients with a wrist fracture, which distal radius accounted for most of them. The AWR had sensitivity and specificity of 0.71 (95% CI: 0.49,0.87) and 1 (95% CI: 0.92,1), respectively. Although the negative likelihood ratio of AWR was 0.29 (95% CI: 0.16,0.54), the positive likelihood ratio was infinite. The positive predicted value was 1 (95% CI: 0.80,1), whereas the negative predictive value was 0.86 (95% CI: 0.74,0.94).

Conclusion: The AWR showed great specificity and positive predictive. It had fair sensitivity, negative predictive value, and negative likelihood ratio for diagnosis of wrist fracture in patients with wrist trauma.