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The predictors used were: sex, age, swelling of the anatomic snuffbox, tenderness in the anatomic snuffbox, scaphoid tubercle tenderness, painful ulnar deviation and painful axial thumb compression. The outcome measure was the presence of a scaphoid fracture, diagnosed on either initial radiographs or during re-evaluation after 1\u20132\u00a0weeks or on additional imaging (radiographs\/MRI\/CT). After multivariate logistic regression analysis and bootstrapping, the regression coefficient for each significant predictor was calculated. The effect of the rule was determined by calculating the number of missed scaphoid fractures and reduction of suspected fractures that required a cast.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A consecutive series of 893 patients with acute wrist injury was included. Sixty-eight patients (7.6%) were diagnosed with a scaphoid fracture. The final prediction rule incorporated sex, swelling of the anatomic snuffbox, tenderness in the anatomic snuffbox, painful ulnar deviation and painful axial thumb compression. Internal validation of the prediction rule showed a sensitivity of 97% and a specificity of 20%. Using this rule, a 15% reduction in unnecessary immobilization and imaging could be achieved with a 50% decreased risk of missing a fracture compared with current clinical practice.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This dataset provided a simple clinical decision rule for scaphoid fractures following acute wrist injury that limits unnecessary immobilization and imaging with a decreased risk of missing a fracture compared to current clinical practice.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Clinical prediction rule<\/jats:title>\n<jats:p>1\/(1\u2009+\u2009EXP (\u2212(0.649662618\u2009\u00d7\u2009if man)\u2009+\u2009(0.51353467826\u2009\u00d7\u2009if swelling anatomic snuffbox)\u2009+\u2009(\u22120.79038263985\u2009\u00d7\u2009if painful palpation anatomic snuffbox)\u2009+\u2009(0.57681198857\u2009\u00d7\u2009if painful ulnar deviation)\u2009+\u2009(0.66499549728\u2009\u00d7\u2009if painful thumb compression)\u22121.685).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial registration<\/jats:title>\n<jats:p>Trial register NTR 2544, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.trialregister.nl\">www.trialregister.nl<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00402-020-03383-w","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T15:02:52Z","timestamp":1583247772000},"page":"575-581","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Detecting scaphoid fractures in wrist injury: a clinical decision rule"],"prefix":"10.1007","volume":"140","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6207-6922","authenticated-orcid":false,"given":"Wouter H.","family":"Mallee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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