A Clinical Decision Rule to Reduce X-Ray Use for Anterior Shoulder Dislocation

Most emergency department patients with anterior shoulder dislocations undergo pre- and postreduction radiography, but is this always necessary? Canadian researchers prospectively derived a shoulder dislocation clinical decision rule (the Quebec decision rule) in a prospective cohort study of consecutive adult patients with anterior glenohumeral dislocation who presented to four university-affiliated EDs over 3 years.

Of 222 eligible patients, 40 (18%) had clinically important fracture-dislocation (defined as “a shoulder fracture associated with an anterior glenohumeral dislocation in which special care was needed during reduction to prevent distraction of previously minimally displaced segments, or in which surgical fixation of segments by …