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Comparative Study
. 2020 Jun;46(3):573-582.
doi: 10.1007/s00068-019-01194-2. Epub 2019 Sep 20.

The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

Marjolein A M Mulders  1 , Monique M J Walenkamp  2 , Nico L Sosef  3 , Frank Ouwehand  4 , Romuald van Velde  5 , Carel J Goslings  6 , Niels W L Schep  7
Affiliations
Comparative Study

The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

Marjolein A M Mulders et al. Eur J Trauma Emerg Surg. 2020 Jun.

Erratum in

Abstract

Purpose: While 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).

Methods: In 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.

Results: A 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.

Conclusion: Implementation of the AWR safely reduces the amount of wrist radiographs in selected patients and consequently reducing the length of stay in the ED.

Keywords: Decision rule; Distal radius; Fracture; Implementation; Radiograph; Trauma.

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Conflict of interest statement

Dr. Mulders, Walenkamp, Sosef, Ouwehand, Van Velde, Goslings and Schep declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
AWR mobile application: patient demographics and clinical findings
Fig. 2
Fig. 2
AWR mobile application: recommendation to make a wrist radiograph or not
Fig. 3
Fig. 3
AWR mobile application: adherence of the physicians
Fig. 4
Fig. 4
Flow diagram of patient selection. Missed inclusions are patients who fulfilled the inclusion criteria but were not included by unknown reasons
Fig. 5
Fig. 5
Physician compliance and missed fractures
See this image and copyright information in PMC

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