Implementation of the Amsterdam Pediatric Wrist Rules

Background: The Amsterdam Pediatric Wrist Rules have been developed and validated to reduce wrist radiographs following wrist trauma in pediatric patients. However, the actual impact should be evaluated in an implementation study. Objective: To evaluate the effect of implementation of the Amsterdam Pediatric Wrist Rules at the emergency department. Materials and methods: A before-and-after comparative prospective cohort study was conducted, including all consecutive patients aged 3 to 18 years presenting at the emergency department with acute wrist trauma. The primary outcome was the difference in the number of wrist radiographs before and after implementation. Secondary outcomes were the number of clinically relevant missed fractures of the distal forearm, the difference in length of stay at the emergency department and physician compliance with the Amsterdam Pediatric Wrist Rules. Results: A total of 408 patients were included. The absolute reduction in radiographs was 19% compared to before implementation (chi-square test, P