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European Journal of Trauma and Emergency Surgery

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Open Access 01-06-2020 | Distal Radius Fracture | Original Article

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

Authors: Marjolein A. M. Mulders, Monique M. J. Walenkamp, Nico L. Sosef, Frank Ouwehand, Romuald van Velde, Carel Goslings, Niels W. L. Schep

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2020

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.

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Title: The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study
Authors: Marjolein A. M. Mulders
Monique M. J. Walenkamp
Nico L. Sosef
Frank Ouwehand
Romuald van Velde
Carel Goslings
Niels W. L. Schep
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Distal Radius Fracture
Scaphoid Fracture
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01194-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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