Quebec Decision Rule in Determining the Need for Radiography in Reduction of Shoulder Dislocation; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
Introduction: The Quebec Decision Rule (QDR) has been developed for deciding on the necessity of radiography for patients with shoulder dislocation. This study aimed to investigate the diagnostic value of QDR in this regard.
Method: This diagnostic accuracy study was conducted on patients with shoulder dislocation visiting the emergency department. After filling out the QDR-based checklist for all patients, they underwent radiography and the obtained radiography results were compared to QDR-based clinical diagnostic findings.
Results: â€Œ 143 patients with the mean age of 32.1Â±12 years were evaluated (88.8% males). Sensitivity, specificity, and positive and negative predictive values of QDR were 50%, 58.2%, 3.3%, and 97.6%, respectively. The sensitivity and specificity were 100% and 50% in patients >40 years old, and 33.3% and 59.8% in those <40 years old. These indices were 33.3% and 60.4%, respectively, in the male sex and 100% and 40% in the female sex.
Conclusion: â€Œ Quebec decision rule holds promise to diagnose concomitant fractures in patients over the age of 40 with 100% sensitivity, thereby reducing the number of radiographies by 50% without causing diagnostic errors. In contrast, this criterion proved inefficient in patients younger than 40. â€Œ
- shoulder dislocation
- decision support techniques
- diagnostic imaging
How to Cite
Cunningham NJ. Techniques for reduction of anteroinferior shoulder dislocation. Emergency Medicine Australasia. 2005;17(5â€6):463-71.
Kesmezacar H. The evaluation and treatment of acute anterior shoulder dislocation. Acta orthopaedica et traumatologica turcica. 2005;39:40-7.
Uehara D, Rudzinski J. [Injuries to the shoulder complex and humerus. Emergency Medicine: a comprehensive study guide] 5th ed ed. New York: McGraw-Hill; 2000.
Wen DY. Current concepts in the treatment of anterior shoulder dislocations. The American journal of emergency medicine. 1999;17(4):401-7.
Ong S, Kelly A-M, Gunn B. Failed validation of the Quebec shoulder dislocation rule for young adult patients in an Australian emergency department. Canadian Journal of Emergency Medicine. 2011;13(3):150-4.
Emond M, Le Sage N, Lavoie A, Rochette L. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2004;11(8):853-8.
Mofidi M, Ahmadi K. Audit on necessity of radiographs in anterior shoulder dislocations. Journal of Mazandaran University of Medical Sciences (JMUMS). 2008;17(62).
Hendey GW, Kinlaw K. Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation. Annals of emergency medicine. 1996;28(4):399-402.
Reid S, Liu M, Ortega H. Anterior shoulder dislocations in pediatric patients: are routine prereduction radiographs necessary? Pediatric emergency care. 2013;29(1):39-42.
Ã‰mond M, Le Sage N, Lavoie A, Moore LJCJoEM. Refinement of the Quebec decision rule for radiography in shoulder dislocation. 2009;11(1):36-43.
Shuster M, Abu-Laban RB, Boyd J, Gauthier C, Shepherd L, Turner C. Prospective evaluation of a guideline for the selective elimination of pre-reduction radiographs in clinically obvious anterior shoulder dislocation. Canadian Journal of Emergency Medicine. 2002;4(4):257-62.
Mofidi M, Ahmadi KJJoMUoMS. Audit on necessity of radiographs in anterior shoulder dislocations. 2008;17(62).
Shuster M, Abu-Laban RB, Boyd J. Prereduction radiographs in clinically evident anterior shoulder dislocation. The American journal of emergency medicine. 1999;17(7):653-8.
Orloski J, Eskin B, Allegra PC, Allegra JR. Do all patients with shoulder dislocations need prereduction x-rays? The American journal of emergency medicine. 2011;29(6):609-12.
Ortells Abuye N. Shoulder dislocations attended in a regional hospital: are all the radiographs ordered necessary. Emergencias. 2014;26:121-4.
- Abstract Viewed: 334 times
- PDF Downloaded: 215 times
- HTML Downloaded: 72 times