PEDIATRICS Vol. 86 No. 1 July 1990, pp. 45-57
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McConnochie, K. M.
Right arrow Articles by Monaco, L. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by McConnochie, K. M.
Right arrow Articles by Monaco, L. P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Prediction Rules for Selective Radiographic Assessment of Extremity Injuries in Children and Adolescents

Kenneth M. McConnochie MD, MPH1, Klaus J. Roghmann PhD1, Joel Pasternack MD1, David J. Monroe MD1, and Liberatore P. Monaco MD1

1 From the Department of Pediatrics, University of Rochester School of Medicine and Rochester General Hospital, New York

To assess the potential for selective use of roentgenography in evaluating extremity injuries, prediction rules were developed based on prospective observations for 617 injured children and adolescents examined in our Emergency Department (phase 1) and tested on 601 examined 1 year later (phase 2). Logit analysis produced best-fitting statistical models for phase 1 data with significant (P < 0.05) direct effects of gross signs, point tenderness, activity not routine, swelling moderate or severe, time from injury <6 hours, and pain with motion for upper extremity injuries; and, for lower extremity injuries, not knee injury, activity not routine, point tenderness, and foot injury. Prediction rules developed in phase 1 performed equally well when tested on phase 2 injuries. Data from both phases were combined, therefore, in analysis that produced risk estimates. For all injury types (ie, for injuries with all possible combinations of presence or absence of these findings), risk for fracture was derived. For upper extremity injuries, with a threshold risk for fracture of 20% used to select specific injury types for roentgenography, prediction rule outcomes were 18.1% of roentgenograms avoided and 5.3% of fractures missed. For lower extremity injuries, using a threshold risk of 10% to select injury types for roentgenography, outcomes were 25.8% of roentgenograms avoided and 5.3% of fractures missed. Alternative prediction rules allowed still greater roentgenogram avoidance, although missed fractures also increased. Risk of adverse functional outcome from missed fractures appeared small. Annual national cost savings from the elimination of 18.1% of upper and 25.8% of lower extremity roentgenographic evaluations was estimated at $103 million.

Key Words: prediction rules • multivariate analysis • extremity injury • radiography

Submitted on February 28, 1989
Accepted on June 21, 1989


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Emerg. Med. J.Home page
D Vijayasankar, A A Boyle, and P Atkinson
Can the Ottawa knee rule be applied to children? A systematic review and meta-analysis of observational studies
Emerg. Med. J., April 1, 2009; 26(4): 250 - 253.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
A P Webster, S Goodacre, D Walker, and D Burke
How do clinical features help identify paediatric patients with fractures following blunt wrist trauma?
Emerg. Med. J., May 1, 2006; 23(5): 354 - 357.
[Abstract] [Full Text] [PDF]

Home page
 radtechHome page
J. MINIGH
Imaging Sports-related Injuries
Radiol. Technol., November 1, 2005; 77(2): 121 - 138.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
P. Petit, C. Sapin, G. Henry, M. Dahan, M. Panuel, B. Bourliere-Najean, K. Chaumoitre, and P. Devred
Rate of Abnormal Osteoarticular Radiographic Findings in Pediatric Patients
Am. J. Roentgenol., April 1, 2001; 176(4): 987 - 990.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
I. G. Stiell, G. A. Wells, R. H. Hoag, M. L. A. Sivilotti, T. F. Cacciotti, P. R. Verbeek, K. T. Greenway, I. McDowell, A. A. Cwinn, G. H. Greenberg, et al.
Implementation of the Ottawa Knee Rule for the Use of Radiography in Acute Knee Injuries
JAMA, December 17, 1997; 278(23): 2075 - 2079.
[Abstract] [PDF]

Home page
 JAMAHome page
I. G. Stiell, G. H. Greenberg, G. A. Wells, I. McDowell, A. A. Cwinn, N. A. Smith, T. F. Cacciotti, and M. L. A. Sivilotti
Prospective Validation of a Decision Rule for the Use of Radiography in Acute Knee Injuries
JAMA, February 28, 1996; 275(8): 611 - 615.
[Abstract] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
V. T. Chande
Decision Rules for Roentgenography of Children With Acute Ankle Injuries
Arch Pediatr Adolesc Med, March 1, 1995; 149(3): 255 - 258.
[Abstract] [PDF]

Home page
 JAMAHome page
I. G. Shell, G. H. Greenberg, R. D. McKnight, R. C. Nair, I. McDowell, M. Reardon, J. P. Stewart, and J. Maloney
Decision Rules for the Use of Radiography in Acute Ankle Injuries: Refinement and Prospective Validation
JAMA, March 3, 1993; 269(9): 1127 - 1132.
[Abstract] [PDF]

Home page
 Med Decis MakingHome page
K. M. McConnochie, K. J. Roghmann, and J. Pasternack
Developing Prediction Rules and Evaluating Observation Patterns Using Categorical Clinical Markers: Two Complementary Procedures
Med Decis Making, February 1, 1993; 13(1): 30 - 42.
[Abstract] [PDF]