Abstract
Introduction:
Scaphoid fractures are common in early adulthood. For acute scaphoid fractures, the sensitivity of X-ray imaging is reported to be as low as 43-70 %. Therefore CT-scanning of the wrist is usually performed in the acute clinical phase in patients with a clinically suspected scaphoid fracture. The aim of this study was to investigate whether the addition of CT-scan in the diagnostic process actually leads to additional diagnoses of scaphoid fractures in adult patients presenting to the Emergency Department (ED).
Method:
This comprises a retrospective cohort study. Patients aged 18 and older, who presented to the ED of our Level 1 trauma centre between October 1st 2015 and February 1st 2021, with (suspected) acute scaphoid fractures were included. Both CT and X-ray diagnostic characteristics were compared with CT scanning of the wrist as golden standard.
Results:
A total of 277 patients were included in this study, of which 60 proved to have a scaphoid fracture visible on the CT scan of the wrist. Compared to the CT scan, a sensitivity of 81,7% (49 out of 60) was found for X-ray, along with an Negative Predictive Value of 94,1% (174 out of 185). Within our sample, we found that CT lead to 7 additional scaphoid fracture diagnoses in the simple FOOSH group. Two of which were incidental findings. The scaphoid fractures that were not seen on X-rays are mostly non-displaced chip fractures, which were treated conservatively.
Discussion:
This data indicates that X-ray imaging is actually much more reliable for ruling out scaphoid fractures than described in previously published literature. A complete (conventional) scaphoid series was only acquired in two out of seven patients with false negative X-rays. This suggests that a complete set of X-rays, including a scaphoid series, is even more reliable than what is found in this study. However, if the level of clinical suspicion is very high, a negative set of X-rays doesn't completely rule out a scaphoid fracture.
Scaphoid fractures are common in early adulthood. For acute scaphoid fractures, the sensitivity of X-ray imaging is reported to be as low as 43-70 %. Therefore CT-scanning of the wrist is usually performed in the acute clinical phase in patients with a clinically suspected scaphoid fracture. The aim of this study was to investigate whether the addition of CT-scan in the diagnostic process actually leads to additional diagnoses of scaphoid fractures in adult patients presenting to the Emergency Department (ED).
Method:
This comprises a retrospective cohort study. Patients aged 18 and older, who presented to the ED of our Level 1 trauma centre between October 1st 2015 and February 1st 2021, with (suspected) acute scaphoid fractures were included. Both CT and X-ray diagnostic characteristics were compared with CT scanning of the wrist as golden standard.
Results:
A total of 277 patients were included in this study, of which 60 proved to have a scaphoid fracture visible on the CT scan of the wrist. Compared to the CT scan, a sensitivity of 81,7% (49 out of 60) was found for X-ray, along with an Negative Predictive Value of 94,1% (174 out of 185). Within our sample, we found that CT lead to 7 additional scaphoid fracture diagnoses in the simple FOOSH group. Two of which were incidental findings. The scaphoid fractures that were not seen on X-rays are mostly non-displaced chip fractures, which were treated conservatively.
Discussion:
This data indicates that X-ray imaging is actually much more reliable for ruling out scaphoid fractures than described in previously published literature. A complete (conventional) scaphoid series was only acquired in two out of seven patients with false negative X-rays. This suggests that a complete set of X-rays, including a scaphoid series, is even more reliable than what is found in this study. However, if the level of clinical suspicion is very high, a negative set of X-rays doesn't completely rule out a scaphoid fracture.
| Original language | English |
|---|---|
| Journal | Emergency Medicine Journal |
| Publication status | In preparation - 2022 |