• Mulders Marjolein A M MAM 0000-0002-0575-0447 Trauma Unit, Department of Surgery, Amsterdam UMC, Location Academic Medical Center, University of Amste, Walenkamp Monique M J MMJ 0000-0003-1371-7687 Trauma Unit, Department of Surgery, Amsterdam UMC, Location Academic Medical Center, University of Amste, Nico L Sosef, Frank Ouwehand, Romuald van Velde, Carel J Goslings, and Schep Niels W L NWL 0000-0002-6475-7286 Department of Trauma and Hand Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands..
• Trauma Unit, Department of Surgery, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. m.a.mulders@amsterdamumc.nl.
• Eur J Trauma Emerg Surg. 2020 Jun 1; 46 (3): 573-582.

PurposeWhile 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).MethodsIn 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.ResultsA total of 402 patients were included. The absolute reduction in wrist radiographs after implementation was 15% (p < 0.001). One clinically irrelevant fracture was missed. Non-fracture patients without wrist radiography due to the AWR spent 34 min less time in the ED compared with non-fracture patients who had a wrist radiograph (p = 0.015). The physicians adhered to the AWR in 36% of patients. Of all patients who did not receive a radiographic examination of the wrist, 87% were satisfied.ConclusionImplementation of the AWR safely reduces the amount of wrist radiographs in selected patients and consequently reducing the length of stay in the ED.

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