Evidence map›Paper›PMID 29992444›Full record

ArticlePediatric radiology2018

Implementation of the Amsterdam Pediatric Wrist Rules.

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

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Pediatric radiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Marjolein A M MuldersTrauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ, Amsterdam, The Netherlands. m.a.mulders@amc.nl.ORCID 0000-0002-0575-0447
Monique M J WalenkampTrauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ, Amsterdam, The Netherlands.
Annelie SlaarDepartment of Radiology, Westfriesgasthuis, P.O. Box 600, 1620 AR, Hoorn, The Netherlands.
Frank OuwehandEmergency Department, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Nico L SosefDepartment of Surgery, Spaarne Gasthuis, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands.
Romuald van VeldeDepartment of Surgery, Tergooi Hospitals, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands.
J Carel GoslingsDepartment of Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
Niels W L SchepDepartment of Trauma and Hand Surgery, Maasstad Hospital, P.O. Box 9100, 3007, AC, Rotterdam, The Netherlands.

Funding

Innovatiefonds Zorgverzekeraars 2953
6 · The paper itself

Abstract

backgroundThe Amsterdam Pediatric Wrist Rules have been developed and validated to reduce wrist radiographs following wrist trauma in pediatric patients. However, the actual impact should be evaluated in an implementation study.

objectiveTo evaluate the effect of implementation of the Amsterdam Pediatric Wrist Rules at the emergency department. MATERIALS AND

methodsA before-and-after comparative prospective cohort study was conducted, including all consecutive patients aged 3 to 18 years presenting at the emergency department with acute wrist trauma. The primary outcome was the difference in the number of wrist radiographs before and after implementation. Secondary outcomes were the number of clinically relevant missed fractures of the distal forearm, the difference in length of stay at the emergency department and physician compliance with the Amsterdam Pediatric Wrist Rules.

resultsA total of 408 patients were included. The absolute reduction in radiographs was 19% compared to before implementation (chi-square test, P<0.001). Non-fracture patients who were discharged without a wrist radiograph had a 26-min shorter stay at the emergency department compared to patients who received a wrist radiograph (68 min vs. 94 min; Mann-Whitney U test, P=0.004). Eight fractures were missed following the recommendation of the Amsterdam Pediatric Wrist Rules. However, only four of them were clinically relevant.

conclusionImplementing the Amsterdam Pediatric Wrist Rules resulted in a significant reduction in wrist radiographs and time spent at the emergency department. The Amsterdam Pediatric Wrist Rules were able to correctly identify 98% of all clinically relevant distal forearm fractures.

Indexed as

Clinical Decision-MakingGuideline AdherenceAdolescentChildChild, PreschoolDiagnostic ErrorsEmergency Service, HospitalFemaleHumansInfantLength of StayMaleNetherlandsProspective StudiesWrist InjuriesAdolescentsChildrenDecision ruleDistal forearmFractureRadiographyTraumaWrist

Identifiers

PMID29992444
PMCPMC6153883

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.