The value of radiographs and bone scintigraphy in suspected scaphoid fracture. A statistical analysis.
The role of radiography and bone scintigraphy in the diagnostic management of suspected scaphoid fracture is controversial. Two strategies were compared for patients with initial negative radiographs: repeated radiography versus selective bone scintigraphy. Using the known positive predictive value of scintigraphy, the sensitivity and specificity of both diagnostic strategies were evaluated in a series of 78 consecutive patients. The kappa value for initial radiographs was 0.76 but decreased to 0.5 for follow-up radiographs. Similarly, sensitivity decreased from 64% to 30% in follow-up radiographs. Specificity of the bone scan was 98%. The best diagnostic strategy in the management of clinically suspected scaphoid fractures consists of initial radiography followed by bone scintigraphy in patients with negative radiographs.
Tiel-van Buul
M M
MM
University of Amsterdam, Department of Nuclear Medicine, The Netherlands.
van Beek
E J
EJ
Borm
J J
JJ
Gubler
F M
FM
Broekhuizen
A H
AH
van Royen
E A
EA
D000328:Adult; D000368:Aged; D002348:Carpal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005596:Fractures, Closed / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography / Q000706:statistics & numerical data; D011877:Radionuclide Imaging / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity