Clinical prediction rule for suspected scaphoid fractures: A prospective cohort study.
BACKGROUND
The low prevalence of true fractures amongst suspected fractures magnifies the shortcomings of the diagnostic tests used to triage suspected scaphoid fractures.


OBJECTIVE
The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a scaphoid fracture than others who lacked the subset criteria.


METHODS
Seventy-eight consecutive patients diagnosed with a suspected scaphoid fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination.


RESULTS
Analysis revealed three significant independent predictors: extension <50%, supination strength ≤ 10% and the presence of a previous fracture.


CONCLUSIONS
Clinical prediction rules have the potential to increase the prevalence of true fractures amongst patients with suspected scaphoid fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage.
Department of Surgery, Medisch Centrum Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands.
S J
SJ
Rhemrev
F J  P
FJ
Beeres
R H
RH
van Leerdam
M
M
Hogervorst
D
D
Ring
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000503:physiopathology; D006230:Hand Injuries / Q000175:diagnosis* / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D021361:Scaphoid Bone / Q000293:injuries*; D012680:Sensitivity and Specificity; D014218:Triage; D055815:Young Adult