On November 12, Eli Brown will be giving Journal Club on this paper:
Failed Validation of the Quebec shoulder dislocation rule for young adult patients in an Australian emergency department. Ong et al., CJEM 2011; 13(3): 150-154.
The Quebec rule, described in 2009, was meant to determine when we need XR to rule out fracture in anterior shoulder dislocations.
The initial prospective cohort study of 222 pts found a 100% sensitivity when they imaged (1) patients younger than 40 if their mechanism of injury involved “substantial force” and (2) patients older than 40 if they had humeral ecchymosis or prior dislocation. 100% sensitivity is good, right?
The paper Eli is going to present is a retrospective cohort study that tried to externally validate the younger-than-40 part of the rule. In 196 Australian patients, the sensitivity of the Quebec rule was 42%. Less good.
So do we throw out the rule? Stay tuned.
You can get the PDF here.