Predictors of Clinically Significant Shoulder Pathology
Predictors of Clinically Significant Shoulder Pathology
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.
Background
Shoulder pain in adults, both acute and chronic, is a common cause for emergency department (ED) visits, accounting for 1–4% of ED admissions. Although there are no clinical decision rules for radiograph use among persons with shoulder pain, they are ordered for most patients. Not surprisingly, many radiographs are normal or nondiagnostic.
Clinical decision rules have been established to eliminate unnecessary x-ray studies in patients with ankle and knee injuries. The goal of these decision rules is to decrease length of stay, hospital and patient costs, and reduce unnecessary radiation exposure. Previously published reviews have demonstrated that plain radiography is overutilized in the evaluation of patients presenting to the ED with shoulder pain, and that clinical factors might define subgroups of low-risk patients in whom plain film radiography need not be performed as part of their initial evaluation. These studies also suggest that specific clinical criteria may be able to identify patients who do not need radiographs as part of the initial management of shoulder pain in general practice. Despite this, no accepted criteria exist regarding the utilization of shoulder radiographs in the setting of shoulder pain.
The objectives of this 5-year retrospective chart review are twofold: first, to identify predictors of clinically significant shoulder pain, and second, to develop clinical decision radiograph-ordering rules for ED patients with shoulder pain.
Abstract and Introduction
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.
Introduction
Background
Shoulder pain in adults, both acute and chronic, is a common cause for emergency department (ED) visits, accounting for 1–4% of ED admissions. Although there are no clinical decision rules for radiograph use among persons with shoulder pain, they are ordered for most patients. Not surprisingly, many radiographs are normal or nondiagnostic.
Importance
Clinical decision rules have been established to eliminate unnecessary x-ray studies in patients with ankle and knee injuries. The goal of these decision rules is to decrease length of stay, hospital and patient costs, and reduce unnecessary radiation exposure. Previously published reviews have demonstrated that plain radiography is overutilized in the evaluation of patients presenting to the ED with shoulder pain, and that clinical factors might define subgroups of low-risk patients in whom plain film radiography need not be performed as part of their initial evaluation. These studies also suggest that specific clinical criteria may be able to identify patients who do not need radiographs as part of the initial management of shoulder pain in general practice. Despite this, no accepted criteria exist regarding the utilization of shoulder radiographs in the setting of shoulder pain.
Goals
The objectives of this 5-year retrospective chart review are twofold: first, to identify predictors of clinically significant shoulder pain, and second, to develop clinical decision radiograph-ordering rules for ED patients with shoulder pain.