What is the incidence of Complex Regional Pain Syndrome type I within four months of a wrist fracture in the adult population? A systematic review

Rolls, Catherine; McCabe, Candy; Llewellyn, Alison; Jones, Gareth

Abstract

Background and Aims
There is wide variation in the estimated incidence of Complex Regional Pain Syndrome (CRPS) prior to the development of the 2010 Budapest diagnostic criteria. Our aim is to establish the incidence of CRPS within four months of a wrist fracture in adults, using a systematic review of the literature published since 2010.

Methods
A systematic search of MEDLINE, PubMed, EMBASE, PsychINFO, CINAHL, BNI and AMED was conducted. The search was limited to observational studies. A validated diagnostic tool and at least one outcome within 4 months were inclusion criteria. Studies reporting on corrective surgical procedures and those with evidence of prior neurology were excluded. Incidence risk was then extracted or calculated, and methodological quality was assessed using a modified Newcastle Ottowa Scale (NOS).

Results
9 studies met all of the criteria. There was a high degree of heterogeneity in study populations including study setting, fracture management, and diagnostic criteria. From the three studies with the highest methodological rigor we determined that the estimate of incidence risk of CRPS falls between 4% and 9% using the Budapest research criteria, rising to 14% using the clinical criteria.

Conclusions
Use of the research and clinical Budapest criteria resulted in lower incidence than the 1994 International Association of Pain criteria. The high specificity and low sensitivity of the research criteria is likely to lead to conservative estimates of incidence, and results should be interpreted with caution if being used to justify health service provision. Further work, including how pain is recorded, is needed to come up with a gold standard diagnostic tool for CRPS.

• Presentation Conference Type: Poster
• Conference Name: EFIC Congress 2019
• Start Date: Sep 4, 2019
• End Date: Sep 7, 2019
• Deposit Date: Oct 17, 2019
• Publicly Available Date: Oct 17, 2019
• Keywords: Complex Regional Pain Syndrome
• Public URL: https://uwe-repository.worktribe.com/output/3863867