Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK; Radiology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK.
Emergency Department, Harrogate District Hospital Foundation Trust, Harrogate, UK.
Radiography (Lond). 2021 May;27(2):377-380. doi: 10.1016/j.radi.2020.09.014. Epub 2020 Sep 30.
Despite scaphoid fractures being relatively uncommon pro-active treatment of suspected fractures has been seen as a risk management strategy. The poor positive predictive value of X-rays has led to published guidelines advocating MRI as a first-line or early imaging tool. It is unclear whether UK hospitals have been able to introduce early scanning and this national survey sought to establish the current management strategies for patients with a suspected scaphoid fracture.
An electronic survey of UK emergency departments (ED) was conducted to establish the initial and follow up strategies for patients with negative imaging. Comparison of first and second-line imaging modalities was undertaken together with review of the clinical speciality responsible for ongoing management.
166 UK NHS Trusts were identified with emergency department facilities of which 66 (39.8%) responded. All sites perform an X-ray as the initial examination. For those with a negative examination ED follow up was the most common approach (54.6%), although many sites refer patients to other specialities including orthopaedics (39.4%) for follow up. The data demonstrated inconsistencies in the number of follow-up episodes and the different imaging investigations utilised. Frustration with the challenges presented by this patient cohort was evident.
The suspected scaphoid fracture represents an ongoing challenge to the NHS with many resource intensive pathways reliant on access to complex imaging investigations.
Our study identified that UK Emergency Departments have limited early access to complex imaging for scanning of the scaphoid. A range of strategies are used for follow up of suspected scaphoid fractures and these are resource intensive. Overtreatment of patients with suspected scaphoid fracture is used as a risk management approach.
尽管舟状骨骨折相对少见，但积极主动地治疗疑似骨折已被视为一种风险管理策略。X 光的阳性预测值较差，导致发表的指南提倡将 MRI 作为一线或早期影像学工具。目前尚不清楚英国的医院是否能够进行早期扫描，本项全国性调查旨在确定目前疑似舟状骨骨折患者的管理策略。
对英国急诊科（ED）进行了电子调查，以确定对影像学阴性患者的初始和随访策略。对一线和二线影像学检查方式进行了比较，并对负责持续管理的临床专业进行了回顾。
共确定了 166 家具有急诊部门设施的英国国民保健服务信托基金，其中 66 家（39.8%）做出了回应。所有的站点都将 X 射线作为初始检查。对于那些检查结果为阴性的患者，急诊科的随访是最常见的方法（54.6%），尽管许多站点将患者转诊至其他专业科室，包括骨科（39.4%）进行随访。数据显示，随访次数和使用的不同影像学检查方法存在不一致性。对该患者群体带来的挑战感到沮丧是显而易见的。
疑似舟状骨骨折对国民保健服务构成了持续挑战，许多资源密集型的途径依赖于复杂的影像学检查。
我们的研究表明，英国急诊科早期获得复杂的舟状骨扫描的机会有限。疑似舟状骨骨折的随访策略多种多样，而且这些策略资源密集。对疑似舟状骨骨折患者的过度治疗被用作一种风险管理策略。
