title: The suspected scaphoid fracture. How useful is a unit policy?
abstract: The records of 196 patients presenting with a clinical suspicion of scaphoid injury were reviewed to evaluate how junior accident and emergency doctors in a teaching hospital managed these patients. The management that was provided was assessed, and it was ascertained whether the presence of a unit policy meant that accident and emergency junior trainees managed patients accordingly. We found that 82% of patients were immobilized for 2 to 13 weeks, with 60 patients (37%) being immobilized for 6 weeks or more. Of the 196 patients presenting with clinical suspicion of scaphoid fracture, a definite scaphoid fracture was found in only 12%. Less than half of the patients (46%) were reviewed by senior accident and emergency doctors or by senior orthopaedic surgeons. Despite the presence of a unit policy, patients were being immobilized for prolonged periods in the absence of a radiographically evident scaphoid fracture. Advice from more experienced members of the staff was not being sought in dubious cases.
authors.affiliation: Department of Accident and Emergency, Aberdeen Royal Hospitals NHS Trust, Foresterhill, Scotland.
authors.forename: J
authors.initials: J
authors.lastname: N'Dow
authors.forename: K
authors.initials: K
authors.lastname: N'Dow
authors.forename: N
authors.initials: N
authors.lastname: Maffulli
authors.forename: G
authors.initials: G
authors.lastname: Page
mesh_terms: D002348:Carpal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D002370:Casts, Surgical; D002985:Clinical Protocols; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital / Q000592:standards*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards; D010808:Physical Examination; D011859:Radiography; D012017:Referral and Consultation; D012606:Scotland