The management of suspected scaphoid fractures in the UK: a national cross-sectional study
Aims: Current National Institute for Health and Clinical Excellence (NICE) guidance advises that MRI direct from the emergency department (ED) should be considered for suspected scaphoid fractures. This study reports the current management of suspected scaphoid fractures in the UK and assesses adher...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2021-11-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.211.BJO-2021-0146 |
| _version_ | 1819044096681967616 |
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| author | Benjamin J. F. Dean *On behalf of the SUSPECT study group |
| author_facet | Benjamin J. F. Dean *On behalf of the SUSPECT study group |
| author_sort | Benjamin J. F. Dean |
| collection | DOAJ |
| description | Aims: Current National Institute for Health and Clinical Excellence (NICE) guidance advises that MRI direct from the emergency department (ED) should be considered for suspected scaphoid fractures. This study reports the current management of suspected scaphoid fractures in the UK and assesses adherence with NICE guidance. Methods: This national cross-sectional study was carried out at 87 NHS centres in the UK involving 122 EDs and 184 minor injuries units (MIUs). The primary outcome was availability of MRI imaging direct from the ED. We also report the specifics of patient management pathways for suspected scaphoid fractures in EDs, MIUs, and orthopaedic services. Overall, 62 of 87 centres (71%) had a guideline for the management of suspected scaphoid fractures. Results: A total of 11 of 87 centres (13%) had MRI directly available from the ED. Overall, 14 centres (17%) used cross-sectional imaging direct from the ED: MRI in 11 (13%), CT in three (3%), and a mixture of MRI/CT in one (1%). Four centres (6%) used cross-sectional imaging direct from the MIU: MRI in three (4%) and CT in two (2%). Of 87 centres’ orthopaedic specialist services, 74 (85%) obtained repeat radiographs, while the most common form of definitive imaging used was MRI in 55 (63%), CT in 16 (19%), mixture of MRI/CT in three (3%), and radiographs in 11 (13%). Conclusion: Only a small minority of centres currently offer MRI directly from the ED for patients with a suspected scaphoid fracture. Further research is needed to investigate the facilitators and barriers to the implementation of NICE guidance. Cite this article: Bone Jt Open 2021;2(11):997–1003. |
| first_indexed | 2024-12-21T10:07:15Z |
| format | Article |
| id | doaj.art-70e8dc808fbe44b68fda4bf0ac13e883 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-21T10:07:15Z |
| publishDate | 2021-11-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-70e8dc808fbe44b68fda4bf0ac13e8832022-12-21T19:07:48ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622021-11-01211997100310.1302/2633-1462.211.BJO-2021-0146The management of suspected scaphoid fractures in the UK: a national cross-sectional studyBenjamin J. F. Dean0*On behalf of the SUSPECT study groupNDORMS, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UKAims: Current National Institute for Health and Clinical Excellence (NICE) guidance advises that MRI direct from the emergency department (ED) should be considered for suspected scaphoid fractures. This study reports the current management of suspected scaphoid fractures in the UK and assesses adherence with NICE guidance. Methods: This national cross-sectional study was carried out at 87 NHS centres in the UK involving 122 EDs and 184 minor injuries units (MIUs). The primary outcome was availability of MRI imaging direct from the ED. We also report the specifics of patient management pathways for suspected scaphoid fractures in EDs, MIUs, and orthopaedic services. Overall, 62 of 87 centres (71%) had a guideline for the management of suspected scaphoid fractures. Results: A total of 11 of 87 centres (13%) had MRI directly available from the ED. Overall, 14 centres (17%) used cross-sectional imaging direct from the ED: MRI in 11 (13%), CT in three (3%), and a mixture of MRI/CT in one (1%). Four centres (6%) used cross-sectional imaging direct from the MIU: MRI in three (4%) and CT in two (2%). Of 87 centres’ orthopaedic specialist services, 74 (85%) obtained repeat radiographs, while the most common form of definitive imaging used was MRI in 55 (63%), CT in 16 (19%), mixture of MRI/CT in three (3%), and radiographs in 11 (13%). Conclusion: Only a small minority of centres currently offer MRI directly from the ED for patients with a suspected scaphoid fracture. Further research is needed to investigate the facilitators and barriers to the implementation of NICE guidance. Cite this article: Bone Jt Open 2021;2(11):997–1003.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.211.BJO-2021-0146scaphoidfracturepathwaynicesuspectedwrist injuryscaphoid fracturesmagnetic resonance imagingradiographsimmobilizationcliniciantraumarandomized controlled trialct scanwristorthopaedic surgeons |
| spellingShingle | Benjamin J. F. Dean *On behalf of the SUSPECT study group The management of suspected scaphoid fractures in the UK: a national cross-sectional study Bone & Joint Open scaphoid fracture pathway nice suspected wrist injury scaphoid fractures magnetic resonance imaging radiographs immobilization clinician trauma randomized controlled trial ct scan wrist orthopaedic surgeons |
| title | The management of suspected scaphoid fractures in the UK: a national cross-sectional study |
| title_full | The management of suspected scaphoid fractures in the UK: a national cross-sectional study |
| title_fullStr | The management of suspected scaphoid fractures in the UK: a national cross-sectional study |
| title_full_unstemmed | The management of suspected scaphoid fractures in the UK: a national cross-sectional study |
| title_short | The management of suspected scaphoid fractures in the UK: a national cross-sectional study |
| title_sort | management of suspected scaphoid fractures in the uk a national cross sectional study |
| topic | scaphoid fracture pathway nice suspected wrist injury scaphoid fractures magnetic resonance imaging radiographs immobilization clinician trauma randomized controlled trial ct scan wrist orthopaedic surgeons |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.211.BJO-2021-0146 |
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