The use of radiographs to evaluate shoulder @entity158 in the XXXX .

@entity1 @entity174 @entity341 @entity158 @entity85 @entity2065
This study was conducted to describe the utilization of plain radiography in the initial evaluation of shoulder @entity158 in the @entity341 ( @entity341 ) and assess the feasibility of developing guidelines for the selective use of shoulder radiographs by determining whether clinical variables are able to discriminate between subjects having therapeutically informative versus uninformative X-rays. The study was a chart review of all adult @entity341 @entity1 presenting to the Boston University Medical Center Hospital (Boston, MA) between January 1994 and January 1996 with a chief complaint that included shoulder @entity158 . Subjects with X-rays were classified into two groups, those with therapeutically informative X-rays (ie, identified conditions requiring specific therapy) and those with therapeutically uninformative X-rays (ie, did not result in specific therapy). Recursive partitioning techniques were then used to identify clinical variables that best distinguished between therapeutically informative and uninformative radiographs. Three hundred twelve @entity1 were included in the analysis, of whom 185 (59%) had shoulder X-rays performed. Thirty-seven (20%) radiographs were therapeutically informative, including 13 @entity2065 , 3 acromioclavicular joint separations, and 21 @entity174 . Deformity present on shoulder examination was the strongest discriminating variable and correctly classified 21 of 23 subjects as having informative X-rays. Of the remaining @entity1 (n = 162), only those older than 43.5 years with a history of a precipitating fall (n = 40) had a high likelihood of having therapeutically informative X-rays. No @entity1 without a @entity85 or precipitating fall (n = 90) had an informative X-ray. These data show that X-rays for the initial evaluation of shoulder @entity158 in the @entity341 are overutilized. This preliminary model suggests that clinical variables are able to distinguish between @entity1 with informative versus uninformative X-rays. Prospective studies are needed to derive valid decision rules for selective use of shoulder radiographs in the @entity341 .
