The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

Purpose While most patients with wrist trauma are routinely referred for radiography, around 50% of these radiographs show no fracture. To avoid unnecessary radiographs, the Amsterdam Wrist Rules (AWR) have previously been developed and validated. The aim of the current study was to evaluate the eff...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2020-06, Vol.46 (3), p.573-582
Main Authors: Mulders, Marjolein A. M., Walenkamp, Monique M. J., Sosef, Nico L., Ouwehand, Frank, van Velde, Romuald, Goslings, Carel, Schep, Niels W. L.
Format: Article
Language:English
Subjects:
Adult
Aged
Arms
Clinical decision making
Critical Care Medicine
Decision making
Decision Support Techniques
Emergency medical care
Emergency Medicine
Emergency Service, Hospital
Female
Fractures
Humans
Intensive
Length of Stay - statistics & numerical data
Male
Medical referrals
Medicine
Medicine & Public Health
Middle Aged
Original
Original Article
Patient assessment
Patient Satisfaction
Prospective Studies
Radiography
Radius Fractures - diagnostic imaging
Sports Medicine
Surgery
Surgical Orthopedics
Trauma
Traumatic Surgery
Unnecessary Procedures
Wrist - diagnostic imaging
Wrist Injuries - diagnostic imaging
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Summary:Purpose While most patients with wrist trauma are routinely referred for radiography, around 50% of these radiographs show no fracture. To avoid unnecessary radiographs, the Amsterdam Wrist Rules (AWR) have previously been developed and validated. The aim of the current study was to evaluate the effect of the implementation of the AWR at the Emergency Department (ED). Methods In a before-and-after comparative prospective cohort study, all consecutive adult patients with acute wrist trauma presenting at the ED of four hospitals were included. Primary outcome was the number of wrist radiographs before and after implementation of the AWR. Secondary outcomes were the number of clinically relevant missed fractures, the overall length of stay in the ED, physician compliance regarding the AWR, and patient satisfaction and experience with the care received at the ED. Results A total of 402 patients were included. The absolute reduction in wrist radiographs after implementation was 15% ( p  
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-019-01194-2