title: Costs analysis and comparison of usefulness of acute MRI and 2 weeks of cast immobilization for clinically suspected scaphoid fractures.
abstract: OBJECTIVE
  Fractures of the scaphoid are often not detected on initial plain radiographs. Conventional management of clinically suspected scaphoid fractures is cast immobilization for 2 weeks and then reassessment. Early MRI is a diagnostic alternative. We compared the cost and usefulness of the early MRI diagnostic strategy with that of conventional management.
  
  
  METHODS
  This prospective pseudo-randomized study included patients between 18 and 49 years of age who attended Bergen Accident and Emergency Department, Bergen, Norway during 1 year in 2009-2010, after sustaining an acute wrist trauma in the previous week and with a clinically suspected scaphoid fracture. 61 patients were investigated with acute MRI, while 63 patients received standard treatment as a control group. We used cost-minimization analysis to estimate the cost of the 2 patient groups.
  
  
  RESULTS
  Concerning cost, there were no statistically significant differences in the total direct medical costs or in indirect costs between the groups. Concerning usefulness, patients in the MRI group without a fracture (n = 35) used a cast for fewer days (mean 1 day) than patients in the control group with no fractures (n = 52) (mean 14 days; p < 0.001). They had less than half the number of days on sick leave than patients in the control group (mean 7 days vs. 15 days; p = 0.002).
  
  
  CONCLUSIONS
  In a Norwegian setting, an early MRI was of value in patients with clinically suspected scaphoid fracture and normal plain radiographs.
authors.affiliation: Bergen Accident and Emergency Department.
authors.forename: Torbjørn H
authors.initials: TH
authors.lastname: Bergh
authors.forename: Knut
authors.initials: K
authors.lastname: Steen
authors.forename: Tommy
authors.initials: T
authors.lastname: Lindau
authors.forename: Lars Atle
authors.initials: LA
authors.lastname: Soldal
authors.forename: Soosaipillai V
authors.initials: SV
authors.lastname: Bernardshaw
authors.forename: Lene
authors.initials: L
authors.lastname: Lunde
authors.forename: Stein Atle
authors.initials: SA
authors.lastname: Lie
authors.forename: Christina
authors.initials: C
authors.lastname: Brudvik
mesh_terms: D000328:Adult; D002370:Casts, Surgical / Q000191:economics*; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009664:Norway; D011446:Prospective Studies; D011859:Radiography / Q000191:economics; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D013997:Time Factors; D014954:Wrist Injuries / Q000191:economics / Q000473:pathology / Q000628:therapy