title: Early computerized tomography accurately determines the presence or absence of scaphoid and other fractures.
abstract: OBJECTIVE
  To validate the use of early CT in predicting scaphoid fracture and other fractures in patients with suspected scaphoid fracture.
  
  
  METHODS
  A prospective observational study of adult patients with a diagnosis of clinical scaphoid fracture presenting to a regional ED. Patients were immobilized in a scaphoid plaster and had a CT (wrist and carpals) same or next day. The gold standard used was the diagnosis on Day 10 with clinical examination and X-rays, with MRI performed in patients with persistent tenderness but normal X-rays.
  
  
  RESULTS
  Forty-seven patients completed the study protocol from September 2004 until February 2006. For all fractures, early CT had a 96.8% negative predictive value and 100% positive predictive value (94.4% sensitive, 100% specific). No scaphoid fracture was missed by early CT. One patient had a trapezium fracture on CT, with a coexistent subtle capitate fracture only detected on MRI.
  
  
  CONCLUSIONS
  Early CT scans show promise in the diagnosis of scaphoid and other fractures of the wrist and carpals. Further study is warranted to validate early CT in clinical scaphoid fracture as an alternative to other early advanced imaging, or plaster immobilization and 2 week review.
authors.affiliation: Emergency Department, Ballarat Health Services, Ballarat, Victoria, Australia. jaycenc@bhs.org.au
authors.forename: Jaycen
authors.initials: J
authors.lastname: Cruickshank
authors.forename: Alex
authors.initials: A
authors.lastname: Meakin
authors.forename: Ross
authors.initials: R
authors.lastname: Breadmore
authors.forename: David
authors.initials: D
authors.lastname: Mitchell
authors.forename: Steven
authors.initials: S
authors.lastname: Pincus
authors.forename: Thomas
authors.initials: T
authors.lastname: Hughes
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Bently
authors.forename: Mark
authors.initials: M
authors.lastname: Harris
authors.forename: Austin
authors.initials: A
authors.lastname: Vo
mesh_terms: D042241:Early Diagnosis; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging* / Q000293:injuries*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*