Display options
Cite
Pincus S, Weber M, Meakin A, et al. Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures. West J Emerg Med. 2009;10(4):227-32
Pincus, S., Weber, M., Meakin, A., Breadmore, R., Mitchell, D., Spencer, L., Anderson, N., Catterson, P., Farish, S., & Cruickshank, J. (2009). Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures. The western journal of emergency medicine, 10(4), 227-32.
Pincus, Steven, et al. "Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures." The western journal of emergency medicine vol. 10,4 (2009): 227-32.
Pincus S, Weber M, Meakin A, Breadmore R, Mitchell D, Spencer L, Anderson N, Catterson P, Farish S, Cruickshank J. Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures. West J Emerg Med. 2009 Nov;10(4):227-32. PMID: 20046238; PMCID: PMC2791722.
Copy Download .nbib Format: NLM
Share it on

West J Emerg Med. 2009 Nov;10(4):227-32.

Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures.

The western journal of emergency medicine

Steven Pincus, Merle Weber, Alex Meakin, Ross Breadmore, David Mitchell, Luke Spencer, Nathan Anderson, Phil Catterson, Steve Farish, Jaycen Cruickshank

Affiliations

  1. Emergency Department, Ballarat Health Services, Ballarat, Victoria, Australia.

PMID: 20046238 PMCID: PMC2791722

Abstract

OBJECTIVE: We developed and implemented clinical practice guideline (CPG) using computerized tomography (CT) as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work.

METHODS: This observational study evaluated implementation of our CPG, which incorporated early wrist CT in patients with "clinical scaphoid fracture": a mechanism of injury consistent with scaphoid fracture, anatomical snuff box tenderness, and normal initial plain x-rays. Outcome measures were the final diagnosis as determined by orthopaedic review of the clinical and imaging data. Patient outcomes included time to return to work and patient satisfaction as determined by telephone interview at ten days.

RESULTS: Eighty patients completed the study protocol in a regional emergency department. In this patient population CT detected 28 fractures in 25 patients, including six scaphoid fractures, five triquetral fractures, four radius fractures, and 13 other related fractures. Fifty-three patients had normal CT. Eight of these patients had significant ongoing pain at follow up and had an MRI, with only two bone bruises identified. The patients with normal CTs avoided prolonged immobilization (mean time in plaster 2.7 days) and had no or minimal time off work (mean 1.6 days). Patient satisfaction was an average 4.2/5.

CONCLUSION: This CPG resulted in rapid and accurate management of patients with suspected occult scaphoid injury, minimized unnecessary immobilization and was acceptable to patients.

References

  1. J Healthc Resour Manag. 1995 Jun;13(6):8-16 - PubMed
  2. Ann Emerg Med. 1995 Oct;26(4):434-8 - PubMed
  3. J Hand Surg Br. 1994 Dec;19(6):748-9 - PubMed
  4. J Bone Joint Surg Am. 2006 Dec;88(12):2695-703 - PubMed
  5. J Nucl Med. 1995 Jan;36(1):45-8 - PubMed
  6. J Trauma. 2005 Sep;59(3):677-81 - PubMed
  7. J Hand Surg Br. 1998 Jun;23(3):324-7 - PubMed
  8. J Comput Assist Tomogr. 1997 Jul-Aug;21(4):511-5 - PubMed
  9. Tech Hand Up Extrem Surg. 2002 Sep;6(3):119-23 - PubMed
  10. Br J Radiol. 2003 May;76(905):296-300 - PubMed
  11. J Nurs Care Qual. 1996 Dec;11(2):54-61 - PubMed
  12. J Hand Surg Br. 2006 Aug;31(4):416-8 - PubMed
  13. J Trauma. 1996 Jul;41(1):73-6 - PubMed
  14. J Bone Joint Surg Am. 2006 Dec;88(12):2750-8 - PubMed
  15. J Trauma. 2004 Oct;57(4):851-4 - PubMed
  16. Lancet. 1993 Nov 27;342(8883):1317-22 - PubMed
  17. Radiology. 1998 Jan;206(1):291-2 - PubMed
  18. AJR Am J Roentgenol. 1997 May;168(5):1287-93 - PubMed
  19. AJR Am J Roentgenol. 2001 Dec;177(6):1257-63 - PubMed
  20. Skeletal Radiol. 1998 Dec;27(12):683-7 - PubMed
  21. J Hand Surg Br. 1993 Jun;18(3):403-6 - PubMed
  22. Radiology. 2006 Jul;240(1):169-76 - PubMed
  23. Scand J Prim Health Care. 1998 Sep;16(3):149-53 - PubMed
  24. J Hand Surg Am. 1988 Mar;13(2):182-7 - PubMed
  25. N Z Med J. 2005 Feb 11;118(1209):U1296 - PubMed
  26. Radiology. 1997 Apr;203(1):245-50 - PubMed
  27. J Hand Surg Am. 2007 Jan;32(1):61-6 - PubMed
  28. AJR Am J Roentgenol. 2006 Dec;187(6):1453-6 - PubMed
  29. Pediatr Radiol. 2000 Oct;30(10):685-8 - PubMed
  30. J Trauma. 1997 Feb;42(2):247-53 - PubMed
  31. Invest Radiol. 1992 Nov;27(11):954-9 - PubMed
  32. Ann R Coll Surg Engl. 2005 Sep;87(5):353-7 - PubMed
  33. Eur J Radiol. 1992 Sep;15(2):118-22 - PubMed
  34. Clin J Sport Med. 2003 May;13(3):164-70 - PubMed
  35. Ann Nucl Med. 2004 Sep;18(6):495-9 - PubMed
  36. Eur J Emerg Med. 2005 Apr;12(2):47-51 - PubMed
  37. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):225-31 - PubMed
  38. Bull Hosp Jt Dis. 1998;57(2):93-5 - PubMed
  39. Emerg Med Australas. 2007 Jun;19(3):223-8 - PubMed

Publication Types