Amsterdam Wrist Rules (AWR).

The incidence of wrist fractures is 400/100.000 in the Netherlands. These types of fractures represent an important amount of the workload in the Emergency Department. There are indications that in patients with wrist trauma most radiological examinations performed are redundant. We present a study whose aim is to develop a clinical decision rule called Amsterdam Wrist Rules (AWR). This decision should helps to determine when an X-ray of the wrist is indicated. After development of the rule the effectiveness of the AWR will be evaluated by attaining two different aims:

1. Is there a decrease in the number of requested X-rays of the wrist after introduction of the AWR?

2. How many fractures of the wrist are missed after introduction of the AWR?

In a subsequent study a cost analysis and a satisfaction survey will be carried out.

Patients with a wrist trauma represent a substantial part of the patient population at the Emergency Department. Most hospitals routinely carry out a radiological examination of patients following wrist trauma to exclude a distal radius fracture. However, a large part of x-rays in these patients (45%) do not show a fracture. Consequently, this means a waste of resources, an increase in patient waiting time and unnecessary radiation exposure. In a large training hospital the yearly costs of unnecessary X-rays performed are estimated on € 85.900,-.

The applicants have developed a clinical decision rule to indicate the need for radiological examination for wrist injuries, called the Amsterdam Wrist Rules (AWR). The objective of this study is to evaluate the decrease in requested radiographs in case of a wrist injury with a suspicion of a distal radius fracture. In addition a cost-effectiveness analysis will be performed of direct and indirect medical costs.

Primairy outcomes: Timpepoint 2 years;

Secondary outcomes: Timepoint 2 years.

Amsterdam Wrist Rules.