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Implementation of the Amsterdam Pediatric Wrist Rules

Marjolein A M Mulders1, Monique M J Walenkamp2, Annelie Slaar3

  • 1Trauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ, Amsterdam, The Netherlands. m.a.mulders@amc.nl.

Pediatric Radiology
|July 12, 2018
PubMed

Insights

Implementing the Amsterdam Pediatric Wrist Rules significantly reduced wrist X-rays and emergency department wait times for pediatric wrist trauma. This clinical decision rule accurately identified 98% of clinically relevant fractures.

Area of Science:

  • Pediatric Emergency Medicine
  • Radiology Decision Support
  • Clinical Implementation Studies

Background:

  • The Amsterdam Pediatric Wrist Rules were developed to decrease unnecessary wrist radiographs in children with wrist injuries.
  • Previous validation studies support the rules' efficacy, but real-world impact requires evaluation.

Purpose of the Study:

  • To assess the effect of implementing the Amsterdam Pediatric Wrist Rules in an emergency department setting.
  • To evaluate the rules' impact on radiograph utilization and patient care.

Main Methods:

  • A prospective cohort study compared outcomes before and after rule implementation in pediatric patients (3-18 years) with acute wrist trauma.
  • Primary outcome: change in wrist radiograph numbers. Secondary outcomes: missed fractures, emergency department length of stay, and physician compliance.

Main Results:

  • A 19% absolute reduction in wrist radiographs was observed post-implementation (P<0.001).
  • Patients without fractures discharged without radiographs had a 26-minute shorter ED stay (P=0.004).
  • Eight fractures were missed, with only four deemed clinically relevant, indicating 98% accuracy for clinically significant fractures.

Conclusions:

  • Implementation of the Amsterdam Pediatric Wrist Rules effectively reduced wrist radiography and emergency department wait times.
  • The rules demonstrated high accuracy in identifying clinically relevant distal forearm fractures, supporting their use in pediatric emergency care.
Abstract

Keywords:
AdolescentsChildrenDecision ruleDistal forearmFractureRadiographyTraumaWrist

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