Title

Predictors of Clinically Significant Radiographic Shoulder Pathology in the Emergency Department

Publication Date

2015

Journal Title

J Emerg Med

Abstract

BACKGROUND: Although there are no clinical decision rules for radiograph use among persons with shoulder pain, they are ordered for most patients. Previously published reviews have demonstrated that radiography is overutilized in evaluating emergency department (ED) patients with shoulder pain, and clinical factors might define patients in whom plain film radiography need not be performed. OBJECTIVES: The objectives of this study were to identify predictors of clinically significant shoulder pain and develop a clinical decision radiograph-ordering rule for adult ED patients with shoulder pain. METHODS: Records from adult ED visits resulting in shoulder radiographs were reviewed. Potential predictors of clinically significant shoulder pain were then identified. Univariate screening was performed to find variables associated with injury and were subsequently included in a multivariable prediction model. RESULTS: Five of the predetermined factors were found to be associated with the likelihood of injury: history of trauma, range of motion, deformity, age, and duration of pain. Receiver operating characteristics revealed an area under the curve of 80%. CONCLUSIONS: Despite accounting for multiple variables, the area under the curve was 80%. Based on these results it is not practical to develop clinical decision radiograph ordering rules for ED patients with shoulder pain.

Volume Number

49

Issue Number

4

Pages

424-8

Document Type

Article

EPub Date

2015/07/15

Status

Faculty; Northwell Researcher

Facility

School of Medicine; Northwell Health

Primary Department

Molecular Medicine

Additional Departments

Occupational Medicine, Epidemiology and Prevention; Emergency Medicine

PMID

26166466

DOI

10.1016/j.jemermed.2015.05.011