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Likelihood Ratio (LR) in Emergency Medicine

1/07/2013

Is it broken?


Clinical Scenario

Anthony, a 15 y/o student, slipped and fell while playng soccer. The next morning he refers continue pain on the right elbow. “Is it broken?” ask Anthony and his father at the triage desktop?
There is pain and edema near the elbow, no radial pulse deficit, he can fully extend and flex the articulation, there aren’t problem about prono-supination.


The doctor smiles and reassures Anthony and his father, “it’s not broken, RICE is enough!!!”.    

  





Conclusion 

An alert patient who refers an elbow contusion and who presents a fully active range of motion has a very low probability to have a fracture. This is a simple, easy and secure rule that reduces X-Ray and time of stay in ED. 
The reccomendation: “Return if the pain persists”, is always valid.  


Bibliography 

MA Darracq
Preservation of active range of motion after acute elbow trauma predicts absence of elbow fracture
AmJ Emerg Med (2008) 26, 779–782 


A.Appelboam.
Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children.
BMJ 2008;337:a2428 doi:10.1136/bmj.a2428 


Ciro Paolillo



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