BACKGROUND: Although only 39  % of @entity1 with wrist @entity130 have sustained a @entity174 , the majority of @entity1 is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects @entity1 with acute wrist @entity130 in the Emergency Department (ED) for radiography. METHODS: This multicenter prospective study consisted of three components: (1) derivation of a clinical prediction model for detecting wrist @entity174 in @entity1 following wrist @entity130 ; (2) external validation of this model; and (3) design of a clinical decision rule. The study was conducted in the EDs of five Dutch hospitals: one academic hospital (derivation cohort) and four regional hospitals (external validation cohort). We included all adult @entity1 with acute wrist @entity130 . The main outcome was @entity174 of the wrist (distal radius, distal ulna or carpal bones) diagnosed on conventional X-rays. RESULTS: A total of 882 @entity1 were analyzed; 487 in the derivation cohort and 395 in the validation cohort. We derived a clinical prediction model with eight variables: age; sex, swelling of the wrist; swelling of the anatomical snuffbox, visible deformation; distal radius tender to palpation; @entity158 on radial deviation and @entity158 . The Area Under the Curve at external validation of this model was 0.81 (95  % CI: 0.77-0.85). The sensitivity and specificity of the Amsterdam Wrist Rules (AWR) in the external validation cohort were 98  % (95  % CI: 95-99  %) and 21  % (95  % CI: 15  %-28). The negative predictive value was 90  % (95  % CI: 81-99  %). CONCLUSIONS: The Amsterdam Wrist Rules is a clinical prediction rule with a high sensitivity and negative predictive value for @entity174 of the wrist. Although external validation showed low specificity and 100  % sensitivity could not be achieved, the Amsterdam Wrist Rules can provide physicians in the Emergency Department with a useful screening tool to select @entity1 with acute wrist @entity130 for radiography. The upcoming implementation study will further reveal the impact of the Amsterdam Wrist Rules on the anticipated reduction of X-rays requested, missed @entity174 , Emergency Department waiting times and health care costs. TRIAL REGISTRATION: This study was registered in the Dutch Trial Registry, reference number NTR2544 on October 1(st), 2010.

The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain', 'painful axial compression of the thumb'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fractures', 'fracture'] @entity130 :: ('MESH:D014947', 'Disease') :: ['trauma']
@entity130 :: (MESH:D014947,Disease) :: ['trauma']
