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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...
Autores principales: | , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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Department of Emergency Medicine, University of California, Irvine School of Medicine
2009
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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. |
format | Text |
id | pubmed-2791722 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2009 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
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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