Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T11:32:20.984Z Has data issue: false hasContentIssue false
  • English
  • Français

Failed validation of the Quebec shoulder dislocation rule for young adult patients in an Australian emergency department

Published online by Cambridge University Press:  11 May 2015

Siang Ong ,
Anne-Maree Kelly  and
Barry Gunn
Siang Ong
Affiliation:
Department of Emergency Medicine, Western Health
Anne-Maree Kelly*
Affiliation:
Joseph Epstein Centre for Emergency Medicine Research at Western Health Department of Medicine, The University of Melbourne, Melbourne, Australia
Barry Gunn
Affiliation:
Department of Emergency Medicine, Western Health
*
JECEMR, Sunshine Hospital, Furlong Road, St Albans, New South Wales 3021, Australia; anne-maree.kelly@wh.org.au.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The Quebec shoulder dislocation rule is a recently derived clinical decision rule to guide physicians on the selective use of radiography in patients with shoulder dislocation. The aim of this studywas to validate the Quebec shoulder dislocation rule.

Methods:

This was a secondary analysis of data collected in a retrospective cohort study. All patients presenting to the emergency department (ED) between January 1, 2003, and October 31, 2008, with a diagnosis of shoulder dislocation or fracture-dislocation were identified from ED management databases. Data collected included demographics, mechanism of injury, and presence of fracture. The outcome of interest was predictive performance of the Quebec shoulder dislocation rule for patients aged under 40 years on this cohort. Data analysis is descriptive.

Results:

Of the 346 patients identified, 196 were aged under 40 years, and 174 (89%) were male; the median age was 25 years (interquartile range 21–29 years), and 58 were recurrent dislocations. One hundred sixteen patients (59%) met the Quebec high-risk criteria, and 80 (41%) were classified as low risk. In the 196 patients aged less than 40 years, 12 fractures as defined were identified (6%). When applied to this cohort, the Quebec clinical decision rule had a sensitivity of 0.42 (95% CI 0.16–0.71), a specificity of 0.40 (95% CI 0.33–0.47), and a negative predictive value of 0.91 (95% CI 0.82–0.96).

Conclusion:

The Quebec shoulder dislocation rule had poor sensitivity for clinically significant fractures associated with shoulder dislocations in young patients (aged 16–39 years) presenting to an Australian emergency department. Its use cannot be recommended.

Keywords

dislocationradiographradiographyshoulder
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 3 , May 2011 , pp. 150 - 154
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Wilson, SR, Price, DD. Dislocation, shoulder. Available at: http://emedicine.medsacpe.com/article/823843/diagnosis (accessed May 16, 2010).Google Scholar
2.Shuster, M, Abu-Laban, RB, Boyd, J, et al. Prospective evaluation of a guideline for the selective elimination of prereduction radiographs in clinically obvious anterior shoulder dislocation. CJEM 2002;4:257–62.Google Scholar
3.Hendey, GW. Necessity of radiographs in the emergency department management of shoulder dislocations. Ann Emerg Med 2000;36:108–13, doi:10.1067/mem.2000.108314.CrossRefGoogle ScholarPubMed
4.Émond, M, Le Sage, N, Lavoie, A, et al. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Acad Emerg Med 2004;11:853–8, doi:10.1111/j.1553-2712.2004.tb00768.x.Google Scholar
5.Bachmann, LM, Kolb, E, Koller, MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003;326:417, doi:10.1136/bmj.326.7386.417.CrossRefGoogle ScholarPubMed
6.Hoffman, JR, Mower, WR, Wolfson, AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000;343:94–9, doi:10.1056/NEJM200007133430203.Google Scholar
7.Émond, M, Le Sage, N, Lavoie, A, et al. Refinement of the Quebec decision rule for radiography in shoulder dislocation. CJEM 2009;11:36–43.Google Scholar
8.Nguyen, TV, Center, JR, Sambrook, PN, et al. Risk factors for proximal forearm, humerus, forearm, and wrist fractures in elderly men and women. Am J Epidemiol 2001;153:587–95, doi:10.1093/aje/153.6.587.CrossRefGoogle ScholarPubMed
9.Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, et al. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996;27:305–8, doi:10.1016/S0196-0644(96)70264-0.Google Scholar