Cost-Effectiveness of Diagnostic Strategies for Suspected Scaphoid Fractures

Yin, Zhong-Gang; Zhang, Jianbing; Гонг, Ке

doi:10.1097/bot.0000000000000316

Cited by 32 publications

(27 citation statements)

References 30 publications

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“…Several studies found that while X‐ray had a 60–70% scaphoid fracture sensitivity, MRI/CT images consistently had a sensitivity of over 95% . A recent prospective study found that when clinically suspected scaphoid fracture patients were imaged, MRI detected 54% more scaphoid fractures than X‐ray .…”

Section: Discussionmentioning

confidence: 99%

“…However, the true cost to the patient and the healthcare system likely outweighs these small differences in imaging cost. Despite an X‐ray being cheaper than a CT or MRI, multiple studies have found that there is either no significant difference in cost or that serial radiographic surveillance is less cost effective than CT or MRI, and that MRI is overall more cost‐effective than CT due to its higher sensitivity . Patient productivity is a major issue with prolonged unnecessary immobilisation of clinically suspected scaphoid fractures, since immobilising scaphoid casts make working difficult, forcing patients to take leave from work and lose wages.…”

Section: Discussionmentioning

confidence: 99%

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The utility of cross‐sectional imaging in the management of suspected scaphoid fractures

Wijetunga

Tsang

Giuffrè

2018

J of Medical Radiation Sci

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The utility of cross‐sectional imaging in the management of suspected scaphoid fractures

Wijetunga

Tsang

Giuffrè

2018

J of Medical Radiation Sci

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“…Although each study showed that the blood loss volume with PFNA was less than with LISS, our research found no significant difference ( P = 0.06) in blood loss between the 2 groups. Yin 22 found that the LISS group received an increased number of blood transfusions and noted that an open surgical technique was the main cause for this significant difference. Moreover, we noted longer incision lengths in the LISS group, which might be an additional explanation.…”

Section: Discussionmentioning

confidence: 99%

Proximal Femoral Nail Antirotation Versus Reverse Less Invasive Stabilization System-distal Femur for Treating Proximal Femoral Fractures

Xuan

Wang

Ma³

et al. 2016

Medicine

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The aim of this study was to compare the effectiveness and safety of 2 surgical techniques that are used to treat proximal femoral fractures.A systematic literature search (up to December 2014) was conducted in Medline, Embase, PubMed, and The Cochrane Central Register of Controlled Trials to screen for studies comparing proximal femoral nail antirotation (PFNA) with less invasive stabilization system–distal femur (LISS-DF) for proximal femoral fractures. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed.A total of 7 studies with 361 patients who satisfied the eligibility criteria included 3 randomized controlled trials and 4 case-controlled trials associated with PFNA versus LISS in treating proximal femoral fractures. Our results demonstrated that there was a significant reduction in hospital stay and time to weight-bearing ambulation and bone healing for PFNA compared with LISS (odds ratio [OR] −1.48, 95% confidence interval [CI] −2.92 to −0.05; OR −7.08, 95% CI −8.32 to −5.84; OR −2.71, 95% CI −4.76 to 0.67). No statistically significant difference was observed between the 2 groups for operative time, blood loss volume, Harris hip score, and incidence of complications.Based on the results of this analysis, we inferred that PFNA is safer and more effective than reverse LISS-DF in patients undergoing osteosynthesis for proximal femoral fractures, and that PFNA is associated with reduced hospital stays and reduced time to weight-bearing ambulation and bone healing. Nonetheless, in certain cases in which PFNA is not suitable due to abnormal structure of the proximal femur or particularly unstable fractures, the LISS plate technique could be a useful alternative.

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“…These authors state that it is not practically, ethically or financially possible to scan every injured wrist with MRI to prevent overtreatment. This conclusion is not in keeping with recent cost-effectiveness studies [8,9]. Clinicians have been historically been wary about recommending widespread scanning due to the fact that little is actually known about the long term outcome of missed occult fractures and the potential for overdiagnosis of entities with unclear significance, such as bone bruising.…”

mentioning

confidence: 92%

“…With increasing availability and reduced cost of advanced imaging, the cost-effectiveness of early magnetic resonance imaging (MRI) or computed tomography (CT) diagnosis has been revisited [8,9] and found favourable. Our ED and fracture clinic has been an early adopter of universal use of MRI scanning to improve diagnosis and reduce unneccesary immobilisation.…”

mentioning

confidence: 99%

A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture

Jenkins

Boyce

Garvey

et al. 2019

The European Research Journal

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Objectives: Suspected scaphoid fractures are a common reason for referral from the emergency department to fracture clinics. Few patients actually have a fracture. Cross sectional imaging has the potential to improve early diagnosis and reduce unneccessary immobilisation. The aim of this audit was to investigate the effectiveness of a virtual pathway, incorporating early magnetic resonance imaging (MRI) scan, for suspected scaphoid fractures. The secondary aim was to investigate whether the accuracy of other clinical signs, such as anatomical snuffbox pain on wrist ulnar deviation, was sufficient to reduce the number of patients requiring a MRI scan. Methods: A prospective audit was undertaken of 123 patients in an emergency department and associated minor injuries unit. These patients were managed with an early MRI scan. Where no significant injury was found, they were discharged after a phone call from a virtual fracture clinic nurse. Results: There were 16 (13%) true scaphoid fractures. MRI scanning showed other injuries including significant soft tissue injuries (13%), other carpal fractures (17%) and fractures of the distal radius (19.5%). The number of clinical appointments required was 0.42 per patient. Eighty patients did not have any face-to-face review. Other clinical examination techniques, such as anatomical snuff box pain on ulnar deviation of the wrist were not sufficiently sensitive or specific to reduce the need for MRI scanning or review. Conclusions: A virtual fracture clinic pathway and early MRI scanning reduced face-to-face reviews and unneccesary immobilisation. Clinical examination techniques are not sufficiently sensitive to reduce the need for scanning.

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Cost-Effectiveness of Diagnostic Strategies for Suspected Scaphoid Fractures

Abstract: Economic and Decision Analyses Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 32 publications

References 30 publications

The utility of cross‐sectional imaging in the management of suspected scaphoid fractures

The utility of cross‐sectional imaging in the management of suspected scaphoid fractures

Proximal Femoral Nail Antirotation Versus Reverse Less Invasive Stabilization System-distal Femur for Treating Proximal Femoral Fractures

A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture

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