Abstract Background Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs. Objective The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rulesinadifferentcohortofpatients.Secondarily,weaimedto compare the performance of these rules with the validated Amsterdam Pediatric Wrist Rules. Materials and methods We included all studies that proposed a clinical prediction or decision rule in children presenting at the emergency department with acute wrist trauma. We performedexternalvalidationwithinacohortof379children.We also calculated the sensitivity, specificity, negative predictive value and positive predictive value of each decision rule. Results We included three clinical decision rules. The sensitivityandspecificityofallclinicaldecisionrulesafterexternal validation were between 94% and 99%, and 11% and 26%, respectively. After external validation 7% to 17% less radiographs would be ordered and 1.4% to 5.7% of all fractures wouldbemissed.ComparedtotheAmsterdamPediatricWrist Rulesonlyoneofthethreeotherruleshadahighersensitivity; however both the specificity and the reduction in requested radiographs were lower in the other three rules. Conclusion The sensitivity of the three non-validated clinical decision rules is high. However the specificity and the reduction in number of requested radiographs are low. In contrast, the validated Amsterdam Pediatric WristRules has anacceptable sensitivity and the greatest reduction in radiographs, at 22%, without missing any clinically relevant fractures.
Keywords Adolescent . .Child .Decisionrule .Distalradius . Fracture .Trauma .Wrist