• Mulders Marjolein A M MAM 0000-0002-0575-0447 Trauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ, Ams, Walenkamp Monique M J MMJ Trauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ, Amsterdam, The Netherlands., Annelie Slaar, Frank Ouwehand, Nico L Sosef, Romuald van Velde, Goslings J Carel JC Department of Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands., and Schep Niels W L NWL Department of Trauma and Hand Surgery, Maasstad Hospital, P.O. Box 9100, 3007, AC, Rotterdam, The Netherlands..
• Trauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ, Amsterdam, The Netherlands. m.a.mulders@amc.nl.
• Pediatr Radiol. 2018 Oct 1; 48 (11): 1612-1620.

BackgroundThe Amsterdam Pediatric Wrist Rules have been developed and validated to reduce wrist radiographs following wrist trauma in pediatric patients. However, the actual impact should be evaluated in an implementation study.ObjectiveTo evaluate the effect of implementation of the Amsterdam Pediatric Wrist Rules at the emergency department.Materials And MethodsA before-and-after comparative prospective cohort study was conducted, including all consecutive patients aged 3 to 18 years presenting at the emergency department with acute wrist trauma. The primary outcome was the difference in the number of wrist radiographs before and after implementation. Secondary outcomes were the number of clinically relevant missed fractures of the distal forearm, the difference in length of stay at the emergency department and physician compliance with the Amsterdam Pediatric Wrist Rules.ResultsA total of 408 patients were included. The absolute reduction in radiographs was 19% compared to before implementation (chi-square test, P<0.001). Non-fracture patients who were discharged without a wrist radiograph had a 26-min shorter stay at the emergency department compared to patients who received a wrist radiograph (68 min vs. 94 min; Mann-Whitney U test, P=0.004). Eight fractures were missed following the recommendation of the Amsterdam Pediatric Wrist Rules. However, only four of them were clinically relevant.ConclusionImplementing the Amsterdam Pediatric Wrist Rules resulted in a significant reduction in wrist radiographs and time spent at the emergency department. The Amsterdam Pediatric Wrist Rules were able to correctly identify 98% of all clinically relevant distal forearm fractures.

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