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Diagnostic tests recommended for the clinical assessment of patients with wrist complaints, an e-Delphi study
Patrick Krastman1, Gerald Kraan2, Yara E van Kooij3
1Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
Background:
Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited.
Purpose:
To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints.
Study Design:
An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed.
Methods:
In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario.
Results:
Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain.
Conclusions:
This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).
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