Current imaging practice for suspected scaphoid fracture in patients with normal initial radiographs: UK-wide national audit

Chunara, M.H.; Mcleavy, C.M.; Kesavanarayanan, V.; Paton, D.; Ganguly, A.

Abstract

BACKGROUND: The prevalence of scaphoid fractures in the young and active patient population is high. Initial suspicion relies on the combination of a clinical examination and scaphoid series. Both of these are imperfect and often result in premature wrist immobilisation, itself associated with significant lifestyle and socioeconomic implications. MRI has been shown to be an effective modality for the investigation of radiographically-occult scaphoid fractures, yet there remains a stark inconsistency in the modality of choice both in the UK and internationally.
METHODS: A survey monkey questionnaire was sent to 140 eligible NHS trusts derived from the NHS England database following exclusion of all non-acute and specialist centres. Four questions were asked regarding the provision of MRI for radiographically-occult scaphoid injuries, time-to-MRI, number of MRI scanners in the trust and any alternative imaging offered.
RESULTS: Responses were received from 74 trusts (53%). Thirty-eight offered MRI as a first-line test in plain-film occult scaphoid injury, 25 preferred CT and 11 opted for repeat plain radiographs. Of the 38 trusts who offered MRI, 26 were able to offer this within 1 week; the remainder provided it within 2 weeks. No trends were identified based on the size of the hospital or its geographical location. Statistical analysis of the data using logit regression, Pearson correlation coefficients and a negative binomial regression revealed no statistically significant relationship between the number of MRI scanners in the department and the ability to provide an MRI, nor between the numbers of MRI scanners and the time-to-MRI.
CONCLUSIONS: There remains a clear disparity, in the UK, in the modality of choice for plain film occult scaphoid injuries. MRI has been consistently recognised in the literature to be a highly-specific, highly-sensitive and cost-effective tool, yet only 51% of trusts who responded provide this service in the UK. Given the patient demographic affected and the resultant loss of working hours from overzealous wrist immobilisation, MRI should be considered as the first-line imaging modality of choice in plain-film occult scaphoid injury, if not a first-line test for acute wrist trauma.

Citation

Chunara, M., Mcleavy, C., Kesavanarayanan, V., Paton, D., & Ganguly, A. (2019). Current imaging practice for suspected scaphoid fracture in patients with normal initial radiographs: UK-wide national audit. Clinical Radiology, 74(6), 450-455. https://doi.org/10.1016/j.crad.2019.02.016

• Journal Article Type: Article
• Acceptance Date: Feb 22, 2019
• Online Publication Date: Apr 3, 2019
• Publication Date: Jun 30, 2019
• Deposit Date: May 9, 2019
• Publicly Available Date: Apr 4, 2020
• Journal: Clinical Radiology
• Print ISSN: 0009-9260
• Electronic ISSN: 1365-229X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 6
• Pages: 450-455
• DOI: https://doi.org/10.1016/j.crad.2019.02.016
• Keywords: Radiology Nuclear Medicine and imaging; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/2034618
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0009926019301321?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Current imaging practice for suspected scaphoid fracture in patients with normal initial radiographs: UK-wide national audit; Journal Title: Clinical Radiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.crad.2019.02.016; Content Type: article; Copyright: © 2019 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.