How do clinical features help identify paediatric patients with fractures following blunt wrist trauma?

OBJECTIVE: Wrist injuries are a common presentation to the emergency department (ED). There are no validated decision rules to help clinicians evaluate paediatric wrist trauma. This study aimed to identify which clinical features are diagnostically useful in deciding the need for a wrist radiograph, and then to develop a clinical decision rule. METHODS: This prospective cohort study was carried out in the ED of Sheffield Children's Hospital. Eligible patients were recruited if presenting within 72 hours following blunt wrist trauma. A standardised data collection form was completed for all patients. The outcome measure was the presence or absence of a fracture. Univariate analysis was performed with the chi2 test. Associated variables (p<0.2) were entered into a multivariate model. Classification and regression tree (CART) analysis was used to derive the clinical decision rule. RESULTS: In total, 227 patients were recruited and 106 children were diagnosed with fractures (47%). Of 10 clinical features analysed, six were found by univariate analysis to be associated with a fracture. CART analysis identified the presence of radial tenderness, focal swelling, or an abnormal supination/pronation as the best discriminatory features. Cross fold validation of this decision rule had a sensitivity of 99.1% (95% confidence interval 94.8% to 100%) and a specificity of 24.0% (17.2% to 32.3%). The radiography rate would be 87%. CONCLUSIONS: Radial tenderness, focal swelling, and abnormal supination/pronation are associated with wrist fractures in children. The clinical decision rule derived from these features had a high sensitivity, but low specificity, and would not substantially alter our current radiography rate. The potential for a clinical decision rule for paediatric wrist trauma appears limited.

The in vivo regulation of liver and kidney glucose-6-phosphatase by dexamethasone.

The microsomal glucose-6-phosphatase enzyme is situated with its active site inside the lumen of the endoplasmic reticulum and for normal enzyme activity in vivo, transport systems are needed for the substrates and products of the enzyme. Most studies of glucose-6-phosphatase have been carried out on the liver enzyme and relatively little is known about the regulation of the kidney glucose-6-phosphatase enzyme system. Here we demonstrate that the liver and kidney glucose-6-phosphatase systems are regulated differently by dexamethasone and that dexamethasone acts on both the glucose-6-phosphatase enzyme and T1 its associated glucose-6-phosphate transport protein.

Qualitative membrane enzyme immunoassay for detection of cytomegalovirus antibody.

A new qualitative membrane immunoassay for use in detecting IgG antibodies to cytomegalovirus (CMV) was compared with a standard microplate enzyme immunoassay (EIA). A total of 179 patients were tested by the EIA for IgG- and IgM-specific antibodies to CMV and then compared with the new membrane immunoassay. Among the 179 sera, five specimens were repeatably invalid. Among the 174 evaluable sera, 128 (73.6%) were positive for IgG antibody to CMV by the EIA method. Of these 128 sera, the Transtat-CMV was positive in 124 (96.9%). The remaining 46 sera were negative for IgG antibodies by both methods. The Transtat-CMV membrane immunoassay appears to be a reliable and easily used method not requiring additional equipment or extended incubation times. As a qualitative-only assay, it cannot be used for diagnosis.