The following is a summary of “External validation of the “deformity, edema, and pain in pronation” model for predicting wrist fractures,” published in the April 2024 issue of Emergency Medicine by Eyler, et al.

For a study, researchers sought to validate externally the “Deformity, Edema, and Pain in Pronation” model, which guides the necessity for radiography in patients with wrist trauma.

The prospective, cross-sectional study was conducted in a tertiary emergency department (ED). Patients aged 18 years and older with wrist trauma were included. Exclusions comprised those without acute blunt wrist trauma, incomplete examination feasibility, and unwilling participants. Each patient underwent assessment by their attending physician, and imaging requests were made based on clinical indications. Blinded to clinical data, orthopedic surgeons evaluated all radiographic images, serving as the standard reference for diagnosing fractures.

The study encompassed 391 patients, with 170 (43.5%) presenting at least one fracture. The sensitivity and specificity of the model for predicting wrist fractures were 98.77% (95% CI: 95.61–99.85) and 27.60% (95% CI 21.82–34.00), respectively. The area under the receiver operating characteristic curve (AUC) during external validation was 0.878 (P < 0.001; 95% CI: 0.844–0.913). Implementing this rule would lead to a 16% reduction in X-ray requests, with only 0.5% of patients potentially missing inoperable fractures.

The “Deformity, Edema, and Pain in Pronation” model proved to be a reliable and practical clinical decision rule for determining the necessity of radiography in wrist trauma cases.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000135