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Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures

OBJECTIVE: We developed and implemented clinical practice guideline (CPG) using computerized tomography (CT) as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return...

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Autores principales: Pincus, Steven, Weber, Merle, Meakin, Alex, Breadmore, Ross, Mitchell, David, Spencer, Luke, Anderson, Nathan, Catterson, Phil, Farish, Steve, Cruickshank, Jaycen
Formato: Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791722/
https://www.ncbi.nlm.nih.gov/pubmed/20046238
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author Pincus, Steven
Weber, Merle
Meakin, Alex
Breadmore, Ross
Mitchell, David
Spencer, Luke
Anderson, Nathan
Catterson, Phil
Farish, Steve
Cruickshank, Jaycen
author_facet Pincus, Steven
Weber, Merle
Meakin, Alex
Breadmore, Ross
Mitchell, David
Spencer, Luke
Anderson, Nathan
Catterson, Phil
Farish, Steve
Cruickshank, Jaycen
author_sort Pincus, Steven
collection PubMed
description OBJECTIVE: We developed and implemented clinical practice guideline (CPG) using computerized tomography (CT) as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work. METHODS: This observational study evaluated implementation of our CPG, which incorporated early wrist CT in patients with “clinical scaphoid fracture”: a mechanism of injury consistent with scaphoid fracture, anatomical snuff box tenderness, and normal initial plain x-rays. Outcome measures were the final diagnosis as determined by orthopaedic review of the clinical and imaging data. Patient outcomes included time to return to work and patient satisfaction as determined by telephone interview at ten days. RESULTS: Eighty patients completed the study protocol in a regional emergency department. In this patient population CT detected 28 fractures in 25 patients, including six scaphoid fractures, five triquetral fractures, four radius fractures, and 13 other related fractures. Fifty-three patients had normal CT. Eight of these patients had significant ongoing pain at follow up and had an MRI, with only two bone bruises identified. The patients with normal CTs avoided prolonged immobilization (mean time in plaster 2.7 days) and had no or minimal time off work (mean 1.6 days). Patient satisfaction was an average 4.2/5. CONCLUSION: This CPG resulted in rapid and accurate management of patients with suspected occult scaphoid injury, minimized unnecessary immobilization and was acceptable to patients.
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spelling pubmed-27917222009-12-31 Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures Pincus, Steven Weber, Merle Meakin, Alex Breadmore, Ross Mitchell, David Spencer, Luke Anderson, Nathan Catterson, Phil Farish, Steve Cruickshank, Jaycen West J Emerg Med International Contributions OBJECTIVE: We developed and implemented clinical practice guideline (CPG) using computerized tomography (CT) as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work. METHODS: This observational study evaluated implementation of our CPG, which incorporated early wrist CT in patients with “clinical scaphoid fracture”: a mechanism of injury consistent with scaphoid fracture, anatomical snuff box tenderness, and normal initial plain x-rays. Outcome measures were the final diagnosis as determined by orthopaedic review of the clinical and imaging data. Patient outcomes included time to return to work and patient satisfaction as determined by telephone interview at ten days. RESULTS: Eighty patients completed the study protocol in a regional emergency department. In this patient population CT detected 28 fractures in 25 patients, including six scaphoid fractures, five triquetral fractures, four radius fractures, and 13 other related fractures. Fifty-three patients had normal CT. Eight of these patients had significant ongoing pain at follow up and had an MRI, with only two bone bruises identified. The patients with normal CTs avoided prolonged immobilization (mean time in plaster 2.7 days) and had no or minimal time off work (mean 1.6 days). Patient satisfaction was an average 4.2/5. CONCLUSION: This CPG resulted in rapid and accurate management of patients with suspected occult scaphoid injury, minimized unnecessary immobilization and was acceptable to patients. Department of Emergency Medicine, University of California, Irvine School of Medicine 2009-11 /pmc/articles/PMC2791722/ /pubmed/20046238 Text en Copyright © 2009 the authors. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle International Contributions
Pincus, Steven
Weber, Merle
Meakin, Alex
Breadmore, Ross
Mitchell, David
Spencer, Luke
Anderson, Nathan
Catterson, Phil
Farish, Steve
Cruickshank, Jaycen
Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures
title Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures
title_full Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures
title_fullStr Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures
title_full_unstemmed Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures
title_short Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures
title_sort introducing a clinical practice guideline using early ct in the diagnosis of scaphoid and other fractures
topic International Contributions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791722/
https://www.ncbi.nlm.nih.gov/pubmed/20046238
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