We have located links that may give you full text access.
Scaphoid Fractures in Children: Do We Need to X-ray? A Retrospective Chart Review of 144 Wrists.
Pediatric Emergency Care 2020 March
OBJECTIVES: The purpose of this study is to determine the predictive value of clinical suspicion for scaphoid fracture in children aged 4 to 11 years, to look at the efficiency and practicality of current management of children presenting to the emergency department, and to help quantify the burden of the treatment strategy of immobilization for 10 to 14 days on clinical grounds despite negative or equivocal x-rays on presentation.
METHODS: We performed a retrospective chart review study of a consecutive sample of all children aged 4 to 11 years old who presented to a tertiary pediatric emergency department from January 1, 2009, to December 31, 2013, within 24 hours of a wrist injury, with a clinical suspicion sufficient to order a scaphoid x-ray. Our primary outcome of interest was the positive predictive value of clinical suspicion of a scaphoid fracture.
RESULTS: There were 142 patients (144 wrists) included in the study. Of these, 110 had a normal initial x-ray. Initial x-rays showed evidence of nonscaphoid fractures in 30 wrists and equivocal scaphoid fractures in 4 wrists. Of the 110 wrists with normal initial x-rays, 69 were immobilized and 52 of those had a follow-up x-ray (47 normal, 1 scaphoid fracture, 1 nonscaphoid fracture, and 3 equivocal evidence of a scaphoid fracture). The positive predictive value was found to be 2.1% to 12.5%.
CONCLUSIONS: This study suggests that children aged 4 to 11 years with clinical suspicion for scaphoid fractures do not necessarily need to be x-rayed or immobilized. A larger multicentered prospective clinical trial would confirm this.
METHODS: We performed a retrospective chart review study of a consecutive sample of all children aged 4 to 11 years old who presented to a tertiary pediatric emergency department from January 1, 2009, to December 31, 2013, within 24 hours of a wrist injury, with a clinical suspicion sufficient to order a scaphoid x-ray. Our primary outcome of interest was the positive predictive value of clinical suspicion of a scaphoid fracture.
RESULTS: There were 142 patients (144 wrists) included in the study. Of these, 110 had a normal initial x-ray. Initial x-rays showed evidence of nonscaphoid fractures in 30 wrists and equivocal scaphoid fractures in 4 wrists. Of the 110 wrists with normal initial x-rays, 69 were immobilized and 52 of those had a follow-up x-ray (47 normal, 1 scaphoid fracture, 1 nonscaphoid fracture, and 3 equivocal evidence of a scaphoid fracture). The positive predictive value was found to be 2.1% to 12.5%.
CONCLUSIONS: This study suggests that children aged 4 to 11 years with clinical suspicion for scaphoid fractures do not necessarily need to be x-rayed or immobilized. A larger multicentered prospective clinical trial would confirm this.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app