A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture
Autor: | Stephen Boyce, Paul J. Jenkins, David Shields, Pauline Garvey, Kevin Bee, L A Rymaszewski |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
030222 orthopedics
medicine.medical_specialty medicine.diagnostic_test business.industry General Engineering Soft tissue 030208 emergency & critical care medicine Magnetic resonance imaging Physical examination Scaphoid fracture Emergency department Wrist medicine.disease Anatomical snuffbox 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Health Care Sciences and Services medicine Ulnar deviation Radiology Sağlık Bilimleri ve Hizmetleri business Scaphoid fracture virtual fracture clinic |
Zdroj: | Volume: 5, Issue: 1 8-13 The European Research Journal |
ISSN: | 2149-3189 |
Popis: | 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. |
Databáze: | OpenAIRE |
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