Early computerized tomography accurately determines the presence or absence of scaphoid and other fractures

Cruickshank, Jaycen; Meakin, Alex; Breadmore, Ross; Mitchell, David; Pincus, Steven; Hughes, Tracey; Bently, Bronwyn; Harris, Mark; Vo, Austin

doi:10.1111/j.1742-6723.2007.00959.x

Cited by 31 publications

(29 citation statements)

References 42 publications

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“…Therefore, it can be assumed that early diagnosis and treatment planning cannot be assured if diagnosis relies on biplane radiography only. This is in concordance with recent reports supporting MDCT as a diagnostic modality of high diagnostic accuracy in scaphoid fracture detection [23][24][25][26] whereas in these reports radiography also was of limited value [23,25,27] . Stevenson et al [24] showed that using initial MDCT an occult scaphoid fracture can be ruled out with the patient returning to regular activity immediately.…”

Section: Resultssupporting

confidence: 92%

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Behzadi

Karul

Henes

et al. 2015

WJR

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AIM:To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography (MDCT) in suspected scaphoid fractures. METHODS:One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities. RESULTS:Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients (42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT (P < 0.01) concerning scaphoid

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Section: Resultssupporting

confidence: 92%

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Behzadi

Karul

Henes

et al. 2015

WJR

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“…These results did not change on sensitivity analysis with the four ED-based studies with LR+ of 23.0 (95% CI = 7.8 to 68) and LR-of 0.18 (95% CI = 0.16 to 0.34). 37,40,77,92 Ilica et al 90 used MRI exclusively as the criterion standard, but estimates of diagnostic accuracy did not differ from other studies using clinical examination, follow-up x-ray, or CT as the criterion standard. All of the studies except for one were prospective study designs, so sensitivity analysis was not conducted based on study design.…”

Section: Ctmentioning

confidence: 99%

“…[36][37][38][39][40] Among more recent, prospective ED-based studies that used MRI or bone scan as criterion standards, the prevalence of scaphoid fractures in patients with appropriate clinical suspicion and nondiagnostic initial x-rays ranges from 17% to 38%. [37][38][39][40] Therefore, based on these four prospective, ED-based diagnostic studies including a total of 274 patients, we think a reasonable pretest probability for adult ED patients with persistent wrist pain suspicious for a scaphoid fracture while still in the ED and normal ED x-rays is 25%. In other words, one in four of these patients will have a scaphoid fracture diagnosed on subsequent imaging.…”

Section: Prevalencementioning

confidence: 99%

“…37,40,77,[88][89][90][91][92] The criterion standard reported varied significantly and included clinical follow-up up to 16 months, 77,92 6-week x-ray, 37,89,91 bone scan, 40 and MRI. 90 The timing of the CT relative to the injury varied from less than 1 day, 37,40,89 to within 4 days, 77,88,91 or 1 week. 90,92 The older studies reported using four-row spiral CTs (120-KV, 100-mA, and 1.5-second scan time with 1.0-to 1.2-mm slices, pitch 3.5, Figure 11.…”

Section: Ctmentioning

confidence: 99%

“…77,88,89 Studies that are more recent used 64-slice spiral CTs with 0.625-to 0.9-mm slices. 40,[90][91][92] Cruickshank et al 37 used four-slice and 64-slice spiral CTs. Sagittal plane images provided lateral views of the scaphoid as evaluated by the central longitudinal axis of the scaphoid, whereas coronal images provide posteroanterior perspectives.…”

Section: Ctmentioning

confidence: 99%

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Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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ObjectivesScaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x‐rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial‐sided tenderness on physical examination. This study was a meta‐analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x‐ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge.MethodsA medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS‐2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta‐analysis was conducted using Meta‐DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow‐up in patients with normal ED x‐rays.ResultsA total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non‐ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS‐2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x‐rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR– = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain.ConclusionsExcept for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x‐rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.

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