The Accuracy of Pain Measurement in Diagnosis of Scaphoid Bone Fractures in Patients with Magnetic Resonance Imaging: Report of 175 Cases

Sharifi,; Hz, Moghaddam; Zakeri, Hosein; Ebrahimi, Mohsen; Saeedian, H; Am, Hashemian

doi:10.5455/medarh.2015.69.161-164

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…This may include the pain score using the visual analogue scale in patients with tenderness of the snuffbox which did not show any prognostic factor to diagnose scaphoid fracture (sensitivity ¼ 87% and specificity ¼ 57% for pain scores 7.5 and higher and 75%, respectively, 72 for scores more or equal to 8.5). 66 For clinical examination, the most accurate test is the scaphoid tubercle tenderness that showed no statistically significant difference with MRI results (p ¼ 0.05), similar to the scaphoid compression test (p ¼ 0.05). For anatomical snuff box tenderness compared to MRI, a statistically significant difference was observed with p ¼ 0.000.…”

Section: Discussionmentioning

confidence: 83%

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Bäcker

Strauch

2019

Jnl Wrist Surg

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Background Scaphoid fracture accounts for approximately 15% of acute wrist fractures. Clinical examination and plain X-rays are commonly used to diagnose the fracture, but this approach may miss up to 16% of fractures in the absence of clear-cut lucent lines on plain radiographs. As such, additional imaging may be required. It is not clear which imaging modality is the best. The goal of this study is to summarize the current literature on scaphoid fractures to evaluate the sensitivity, specificity, and accuracy of four different imaging modalities. Case Description A systematic-review and meta-analysis was performed. The search term “scaphoid fracture” was used and all prospective articles investigating magnetic resonance imaging (MRI), computed tomography (CT), bone scintigraphy, and ultrasound were included. In total, 2,808 abstracts were reviewed. Of these, 42 articles investigating 51 different diagnostic tools in 2,507 patients were included. Literature Review The mean age was 34.1 ± 5.7 years, and the overall incidence of scaphoid fractures missed on X-ray and diagnosed on advanced imaging was 21.8%. MRI had the highest sensitivity and specificity for diagnosing scaphoid fractures, which were 94.2 and 97.7%, respectively, followed by CT scan with a sensitivity and specificity at 81.5 and 96.0%, respectively. The sensitivity and specificity of ultrasound were 81.5 and 77.4%, respectively. Significant differences between MRI, bone scintigraphy, CT, and ultrasound were identified. Clinical Relevance MRI has higher sensitivity and specificity than CT scan, bone scintigraphy, or ultrasound. Level of Evidence This is a Level II systematic review.

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Section: Discussionmentioning

confidence: 83%

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Bäcker

Strauch

2019

Jnl Wrist Surg

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“…History taking, physical examination and imaging as index tests were investigated in 0, 20% ( Diagnosing carpal fractures in hospital care Table 5 presents the accuracy of the diagnostic tests of all the carpal fractures. Two studies described the diagnostic accuracy of history taking [62,67]. Physical examination [48,53,62,64] and combined physical and radiological examination [52] for diagnosing scaphoid fractures showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Krastman

Mathijssen

Bierma-Zeinstra

et al. 2020

BMC Musculoskelet Disord

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Background: The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods: A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results: Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. Conclusions: Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

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“…The main outcome was that the pain scores were measured using a visual analog scale (VAS), which is an instrument for measuring subjective characteristics, such as pain, that cannot be quantified directly. Sharifi and colleagues ( 6 ) used VAS to measure pain in patients with scaphoid bone fractures. In VAS, the patients specify their level of pain by indicating a position along a continuous line between two end-points ( 7 ).…”

Section: Methodsmentioning

confidence: 99%

Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial

Sharifi¹,

Doloo²,

Hashemian³

et al. 2016

Electron physician

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BackgroundCervical spine trauma occurs mostly among young males due to falls and car accidents. The CT scan technology is replacing radiography in many medical clinics as it is very capable in detecting subtle cervical spine injuries. However, the use of CT scan for routine screening in patients with cervical spine trauma remains controversial due to its radiation risks and relatively high cost.ObjectiveThe focus of this research was on using morphine in patients with cervical spine trauma. The objective was to determine the ability of morphine to reduce the number of patients in need of CT scans.MethodsThis double-blinded randomized clinical trial study was conducted from April 2014 to March 2015 in Hasheminejad Hospital in Mashhad, Iran. We enrolled 67 patients with cervical spine trauma and normal radiography in the study. They were divided randomly into two groups (groups A and B), where group A received intravenous morphine, and group B received a placebo. We measured the pain scores in both groups before giving the medication and 10 minutes afterwards using a visual analog scale (VAS).ResultsAs a result of receiving morphine, the patients in group A had significantly lower pain than group B (p-value < 0.001). The average pain score in group A was reduced by 43% versus 23% in group B. However, the most pain reduction was in those in group A with a normal CT scan. The pain score of these patients dropped by 52%.ConclusionsThe findings of this study suggest that patients with a normal radiography may be discharged with a cervical collar without a need for a CT scan if morphine reduces their pain. This is because the pain in these patients stem from the muscles and non-bony structures in the cervical spine area. Clinical trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2013100214872N1FundingThe authors received no financial support for the research or for the publication of this article.

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The Accuracy of Pain Measurement in Diagnosis of Scaphoid Bone Fractures in Patients with Magnetic Resonance Imaging: Report of 175 Cases

Cited by 6 publications

References 24 publications

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial

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