Variatie in beleid bij vermoeden op scafoïdfractuur

Objective

This study evaluated the daily clinical practice for management of patients with suspected scaphoid fractures in hospitals in the Netherlands and compared it with recomendations from the current literature.

Design

Questionnaire-based investigation.

Method

Doctors working in emergency departments in hospitals in the Netherlands were asked to complete an 8-question survey including questions on diagnostic strategies, treatment type and the time between different steps in the management policy.

Results

Doctors from 90 of the 100 hospitals approached completed the questionnaire. A total of 71 of these 90 hospitals had an established protocol. In the other 19 it depended on the preference of the treating doctor. In 75 hospitals a follow-up outpatient clinic appointment was made for within 10 days. In 70 hospitals X-rays were repeated before additional imaging investigation. CT was the most frequently used additional investigation in 35 hospitals, followed by bone scintigraphy (12) and MRI (2). No additional investigation was carried out in 11 hospitals and when X-rays showed no abnormalities treatment was implemented on the basis of clinical evaluation. In 72 hospitals the wrist was immobilised with a lower-arm plaster cast including the thumb. Lower-arm plaster cast not including the thumb was used in 1 hospital.

Conclusion

There is a great deal of variation in diagnosis and treatment of patients with a suspected scaphoid fracture within hospitals in the Netherlands. Furthermore, management policy in most hospitals is not in keeping with the most recent recommendations. Evidence-based guidelines are required in order to limit over-diagnosis and unnecessary immobilisation.

Conflict of interest: L. Blankevoort and C.N. van Dijk received grants for their research institute from Medical vision, Factory CRO, DJO, ICON, Biomet, Boehringer Ingelheim, Zimmer, Arthrosurface, Carbylan Biosurgery, Astellas, Stryker and GlaxoSmithKline. Financial support for this article: none declared.