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@article{0327f95f439a4bf9b2e42ae7b5da1d89,
title = "The addition of Computed Tomography to X-ray imaging for diagnosing suspected scaphoid fractures: a retrospective cohort study.",
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.",
author = "Vlaar, {Stefan P.} and Scheerder, {Maeke J.} and Tim Schepers and Ridderikhof, {Milan L.}",
year = "2022",
language = "English",
journal = "Emergency medicine journal",
issn = "1472-0205",
publisher = "BMJ Publishing Group",

}

RIS

TY - JOUR

T1 - The addition of Computed Tomography to X-ray imaging for diagnosing suspected scaphoid fractures: a retrospective cohort study.

AU - Vlaar, Stefan P.

AU - Scheerder, Maeke J.

AU - Schepers, Tim

AU - Ridderikhof, Milan L.

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

M3 - Article

JO - Emergency medicine journal

JF - Emergency medicine journal

SN - 1472-0205

ER -

ID: 23923738