External Validation of the "Deformity, Edema, and Pain in Pronation" Model for Predicting Wrist Fractures
Authors: Yesim Eyler, Mustafa Sever, Ali Turgut, Necmiye Yalcin Ocak, Ahmet Onata, Olcay Gürsoy
Published in: American Journal of Emergency Medicine, 2024 January 15
Conclusion:
- The "Deformity, Edema, and Pain in Pronation" model is a reliable and practical rule for deciding the need for radiography in wrist trauma cases.
Methods:
- A prospective, cross-sectional study conducted in a tertiary emergency department (ED).
- Inclusion: Patients aged 18 years and older presenting to the ED with wrist trauma.
- Exclusion: Patients without acute and blunt wrist trauma, those who couldn't be fully examined, and those unwilling to participate.
- Responsible physicians examined each patient, and imaging tests were requested as indicated.
- An orthopedic surgeon, blinded to clinical information, evaluated all radiographic images, serving as the standard for diagnosing fractures.
Results:
- Total of 391 patients included; 170 (43.5%) had at least one fracture.
- Sensitivity and specificity of the model: 98.77% (95% CI: 95.61-99.85) and 27.60% (95% CI: 21.82-34.00), respectively.
- The area under the receiver operating characteristic curve (AUC) for external validation: 0.878 (p < 0.001; 95% CI: 0.844-0.913).
- Implementation of this rule would reduce X-ray imaging requests by 16%, with only 0.5% of patients potentially missing inoperable fractures.