Pesquisadores canadenses publicaram, recentemente, no Academic Emergency Medicine, um estudo em que procuraram identificar fatores de risco para ocorrncia de fraturas associadas a luxaes anteriores de ombro, tratadas em Departamento de Emergncia de um hospital universitrio.
Foi realizado um estudo caso-controle retrospectivo, de cinco anos, em que se identificaram pacientes que apresentaram luxao anterior de ombro, tratados e acompanhados em Departamento de Emergncia de um hospital universitrio. Dados da entrevista com os pacientes ao momento da admisso revelaram possveis fatores preditivos de fraturas. Os indivduos considerados casos foram aqueles que apresentaram fratura clinicamente importante associada luxao anterior de ombro, enquanto que o grupo controle foi constitudo por pacientes que permaneceram com luxao anterior de ombro, sem complicaes.
No total, foram includos no estudo 344 pacientes. Oitenta e cinco indivduos (25,5%) apresentaram fratura-luxao de ombro importante, e os demais 249 (74,5%) permaneceram com luxao anterior, no complicada. anlise estatstica, identificou-se que idade igual ou superior a 40 anos, ocorrncia prvia do primeiro episdio de luxao e o mecanismo de luxao de ombro, como, por exemplo, queda superior a um lance de escada, episdio de luta ou assalto, ou acidente com veculo, so fatores de risco significantes para ocorrncia de fratura-luxao anterior de ombro. Os odds ratios associados a cada fator de risco foram, respectivamente, iguais a 5,18 (IC95% = 2,74 9,78), 4,23 (IC95% = 1,82 9,87) e 4,06 (IC95% = 1,95 8,48).
Portanto, os pesquisadores concluram que idade, ocorrncia prvia do primeiro episdio e mecanismo de luxao so fatores preditivos do risco de fratura-luxao anterior de ombro.
Clinical Factors Predicting Fractures Associated with an Anterior Shoulder Dislocation - Academic Emergency Medicine; 2004; 11(8): 853-858
Clinical Factors Predicting Fractures Associated with an Anterior Shoulder Dislocation
Marcel mond, MD, MSc, Natalie Le Sage, MD, MSc, Andr Lavoie, PhD and Louis Rochette, MSc
From the Trauma Research Unit, Centre Hospitalier Affili Universitaire de Qubec (ME, NL, AL), Emergency Medicine Division, Department of Family Medicine (ME, NL), and Department of Social and Preventive Medicine (AL, LR), Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
Address for correspondence and reprints: Marcel mond, MD, MSc, Trauma Research Unit, Centre Hospitalier Affili Universitaire de Qubec, site Enfant-Jsus, 1401, 18ime rue, Quebec City, Quebec, Canada G1J 1Z4. Fax: 418-649-5733; e-mail: marcelemond@hotmail.com.
Objectives: To identify risk factors for fractures associated with an anterior shoulder dislocation treated in an emergency department (ED). Methods: A retrospective casecontrol study over five years of patients with an anterior shoulder dislocation was accomplished in a university-affiliated ED. Chart review identified possible predictors of fractures. Comparing the profile of patients having a clinically important fracture associated with their shoulder dislocation (cases) with those sustaining a noncomplicated dislocation (controls) provided the outcome measure. Results: A total of 334 patients were included in the study. Eighty-five (25.5%) had a clinically important fracture-dislocation, and the remaining 249 (74.5%) sustained a noncomplicated shoulder dislocation. Chi-square, logistic regression, and recursive partitioning analysis showed three significant factors for the presence of fracture-dislocation: 1) age 40 years or older, 2) a first episode of dislocation, and 3) mechanism of injury (i.e., a fall greater than one flight of stairs, a fight/assault episode, or a motor vehicle crash). A multiple logistic regression model estimated the significant adjusted odds ratios (and their 95% confidence intervals [95% CIs]) for each of the three factors: 5.18 (95% CI = 2.74 to 9.78), 4.23 (95% CI = 1.82 to 9.87), and 4.06 (95% CI = 1.95 to 8.48), respectively. A predictive model using any one of the three factors reached a sensitivity of 97.7% (95% CI = 91.8% to 99.4%), a specificity of 22.9% (95% CI = 18.1% to 28.5%), and a negative predictive value of 96.6% (95% CI = 88.3% to 99.6%). Conclusions: Three risk factors predict clinically important fractures that are associated with shoulder dislocation: age, first episode, and mechanism of dislocation. A prospective validation may lead to standardized use of prereduction radiographs of the shoulder in the ED.
Key words: shoulder dislocation; emergency medicine; clinical decision rules; shoulder fractures; radiology; anterior shoulder dislocation
