1632 Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies

Aims, Objectives and Background Pre-reduction radiographs are conventionally used to exclude important fracture before attempts reduce a dislocated shoulder in the Emergency Department. However, this step increases cost, exposes patients ionising radiation, might delay closed reduction. Some studies have suggested that pre-reduction imaging may be omitted for sub-group of with dislocations. The objective was determine whether clinical predictors can identify safely undergo reduction without radiographs. Method Design A systematic review meta-analysis diagnostic test accuracy evaluated ability features concomitant fractures dislocation. All were included except Hill-Sachs lesions. Quality assessment undertaken using Assessment Diagnostic Accuracy Studies (QUADAS-2) tool. Data pooled meta-analysed by fitting univariate random effects multi-level mixed logistic regression models. Results Conclusion Eight reported data on 2,087 dislocations 343 fractures. prevalence 17.5%. most accurate age >40 (LR+ 1.8 [95% CI 1.5–2.1]; LR- 0.4 [0.2–0.6]), female sex 2.0 [1.6–2.4], 0.7 [0.6–0.8]), first time dislocation 1.7 [1.4–2.0]; LR-0.2 [0.1–0.5]), presence humeral ecchymosis 3.0–5.7; 0.8–1.1). mechanisms injury were: high-energy mechanism fall 2.0–9.8), >1 flight stairs 3.8 0.6–13.1]; 1.0 0.9–1.0]), motor vehicle collision 2.3 [0.5–4.0]; 0.9 [0.9–1.0]). Quebec Rule had sensitivity 92.2% (95% 54.6–99.2%) specificity (33.3%, 23.1–45.3%) but Fresno-Quebec rule maintained 100% across three 564 98 In conclusion, has undergone both internal external validation now role practice.