title: Development of a clinical decision tool for suspected scaphoid fractures.
abstract: Scaphoid fractures are the most common carpal fractures; their overall incidence is however low. Missing a scaphoid fracture may lead to a non-union with a possible disastrous outcome for the patient; for this reason, treatment of a suspected scaphoid fracture, even without a proven fracture on the first radiograph, has been conservative with plaster treatment. There are many clinical tests developed to diagnose a scaphoid fracture. However not all tests are equally practical, and their sensitivity and specificity are not always known, or are very low. In this study 18 clinical tests were evaluated and a subset of 7 tests remained, which were found to be practical and/or had a high enough sensitivity. A clinical decision protocol was developed using a combination of these seven tests, in order to improve diagnostic accuracy and at the same time reduce unnecessary plaster cast treatment of patients with a suspected scaphoid, who turn out to only have a sprained wrist.
authors.affiliation: Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands. p.Steenvoorde@rijnland.nl
authors.forename: Pascal
authors.initials: P
authors.lastname: Steenvoorde
authors.forename: Cathrien
authors.initials: C
authors.lastname: Jacobi
authors.forename: Alex
authors.initials: A
authors.lastname: van der Lecq
authors.forename: Louk
authors.initials: L
authors.lastname: van Doorn
authors.forename: Job
authors.initials: J
authors.lastname: Kievit
authors.forename: Jacques
authors.initials: J
authors.lastname: Oskam
mesh_terms: D003657:Decision Making; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D021361:Scaphoid Bone / Q000293:injuries*; D012680:Sensitivity and Specificity