Shoulder Dislocation Clinical Trial
Official title:
Selective Radiography in Anterior Shoulder Dislocation: Prospective Validation Rule of Decision Rules Derived in Fresno and Quebec
To compare and validate the two clinical algorithms
Clinical Decision rules have safely and successfully allowed clinicians to reduce the total
number of radiographs ordered, while detecting patients with important pathology or
injuries. The Ottawa Ankle and Knee Rules were developed from a series of studies, and have
successfully reduced the number of radiographs ordered by physicians without missing serious
ankle fractures (1-4). Likewise, the NEXUS group developed a clinical decision rule for the
selection of blunt trauma patients who are appropriate for imaging, based on clinical
features (5).
Drs. Hendey and Emond have separately developed similar algorithms for selective radiography
in patients with a suspected shoulder dislocation (6-10). The goal of the current study is
to compare and validate the two clinical algorithms.
Both approaches examine clinical features that are readily accessible to the physician at
the time of ED evaluation. In the pre-reduction assessment, both algorithms included the
mechanism of injury and whether the patient had experienced a previous shoulder dislocation.
Hendey additionally assessed whether the physician was clinically confident of the
dislocation (8). Emond additionally included the age of the patient, and the presence or
absence of humeral ecchymosis (9). In the post-reduction assessment, both algorithms
emphasize the importance of clinical certainty of reduction, as well as the presence of a
fracture dislocation.
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Time Perspective: Prospective
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