Dean Benjamin J F
NDORMS, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK.
Bone Jt Open. 2021 Nov;2(11):997-1003. doi: 10.1302/2633-1462.211.BJO-2021-0146.
Current National Institute for Health and Clinical Excellence (NICE) guidance advises that MRI direct from the emergency department (ED) should be considered for suspected scaphoid fractures. This study reports the current management of suspected scaphoid fractures in the UK and assesses adherence with NICE guidance.
This national cross-sectional study was carried out at 87 NHS centres in the UK involving 122 EDs and 184 minor injuries units (MIUs). The primary outcome was availability of MRI imaging direct from the ED. We also report the specifics of patient management pathways for suspected scaphoid fractures in EDs, MIUs, and orthopaedic services. Overall, 62 of 87 centres (71%) had a guideline for the management of suspected scaphoid fractures.
A total of 11 of 87 centres (13%) had MRI directly available from the ED. Overall, 14 centres (17%) used cross-sectional imaging direct from the ED: MRI in 11 (13%), CT in three (3%), and a mixture of MRI/CT in one (1%). Four centres (6%) used cross-sectional imaging direct from the MIU: MRI in three (4%) and CT in two (2%). Of 87 centres' orthopaedic specialist services, 74 (85%) obtained repeat radiographs, while the most common form of definitive imaging used was MRI in 55 (63%), CT in 16 (19%), mixture of MRI/CT in three (3%), and radiographs in 11 (13%).
Only a small minority of centres currently offer MRI directly from the ED for patients with a suspected scaphoid fracture. Further research is needed to investigate the facilitators and barriers to the implementation of NICE guidance. Cite this article: 2021;2(11):997-1003.
英国国家卫生与临床优化研究所（NICE）目前的指南建议，对于疑似舟状骨骨折的患者，应考虑直接在急诊科（ED）进行磁共振成像（MRI）检查。本研究报告了英国目前对疑似舟状骨骨折的处理情况，并评估了对NICE指南的遵循情况。
这项全国性横断面研究在英国的87个国民保健服务（NHS）中心开展，涉及122个急诊科和184个轻伤单位（MIU）。主要结果是能否直接在急诊科进行MRI成像检查。我们还报告了急诊科、轻伤单位和骨科服务中疑似舟状骨骨折患者的具体管理路径。总体而言，87个中心中有62个（71%）有疑似舟状骨骨折的管理指南。
87个中心中共有11个（13%）可直接在急诊科进行MRI检查。总体而言，14个中心（17%）直接在急诊科使用横断面成像检查：11个（13%）使用MRI，3个（3%）使用CT，1个（1%）同时使用MRI/CT。4个中心（6%）直接在轻伤单位使用横断面成像检查：3个（4%）使用MRI，2个（2%）使用CT。在87个中心的骨科专科服务中，74个（85%）进行了重复X线摄影，而最常用的确定性成像方式是MRI，共55个（63%）；CT为16个（19%）；MRI/CT混合使用为3个（3%）；X线摄影为11个（13%）。
目前只有极少数中心为疑似舟状骨骨折的患者直接在急诊科提供MRI检查。需要进一步研究以调查实施NICE指南的促进因素和障碍。引用本文：2021；2(11):997 - 1,003。
