• Yunus Karaca, Suha Turkmen, Aysegul Cansu, Mehmet Emre Baki, Oguz Eroglu, Ozgur Tatli, Mucahit Gunaydin, Ercument Beyhun, Abdulkadir Gunduz, Umut Eryiğit, Ahmet Baydın, Murat Güzel, Faruk Özşahin, Özlem Bilir, Aynur Şahin, Veyis Taşın, Aslan Kalay, Orkun Gül, and Suleyman Turedi.
• Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
• Am J Emerg Med. 2016 Nov 1; 34 (11): 2074-2078.

IntroductionThe aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma.MethodsThis prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture.ResultsA total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%.ConclusionWith their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.Copyright © 2016 Elsevier Inc. All rights reserved.

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