OBJECTIVE: In a previous retrospective study, we had found that shoulder radiographs were overused in the initial evaluation of @entity1 presenting to the emergency department with @entity158 . Our objective was to prospectively define clinical criteria that identify @entity1 who have a low risk of radiographic findings that influence the management of the initial evaluation of @entity158 in the emergency department. METHODS: All adult @entity1 presenting to the emergency department of a university teaching hospital with @entity158 were eligible to participate. @entity1 with @entity85 , penetrating wounds, @entity158 , and those presenting for followup were excluded. Data were recorded prospectively using a standardized form. All radiographs were classified as therapeutically uninformative (TU) except @entity174 , @entity2720 (> or =Grade 3), @entity281 , or @entity5 . A classification tree was used for analysis. RESULTS: Two hundred six @entity1 had shoulder radiographs, of which 88% were TU. The model yielded 3 sets of low risk @entity1 with a high percentage of TU radiographs: (1) no fall, no swelling (99% TU: 106 TU, 1 radiograph with @entity75 in a @entity5 @entity1 ); (2) a fall, but no swelling, and no @entity158 at rest (100% TU, n = 18); (3) a fall and @entity158 at rest, but no swelling and normal range of motion (100% TU, n = 10). Not performing radiographs on these low risk @entity1 would have decreased radiograph utilization from 52 to 18% of all shoulder @entity1 seen. CONCLUSION: Our findings suggest that specific clinical criteria are able to identify @entity1 who do not need radiographs as part of the initial management of @entity158 . Prospective validation of these criteria are needed to confirm that these low risk @entity1 can be safely evaluated without radiographs.

Improving the selective use of plain radiographs in the initial evaluation of XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fracture'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer', 'malignancy'] @entity75 :: ('MESH:D001927', 'Disease') :: ['lytic lesions'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity158 :: ('MESH:D010146', 'Disease') :: ['referred pain', 'pain', 'shoulder pain'] @entity2720 :: ('MESH:D007592', 'Disease') :: ['acromioclavicular joint separation'] @entity85 :: ('MESH:D009140', 'Disease') :: ['deformities']
@entity158 :: (MESH:D010146,Disease) :: ['shoulder pain']
