Not the recommendation for sure! We said that for scaphoid fractures, plain films are not that sensitive (meaning that there is a significant false negative rate). That is why we immobilize those patients where our clinical suspicion for fracture is high and refer them as outpatients to their PMD or to ortho where they will get another round of examination and imaging down the line. Despite the poor test characteristics of plain films, we still start with them in the ED because when they are positive, we have our diagnosis! We talked about the fact that MRI is a better test than plain film for ruling in (or out) scaphoid fracture, but we mentioned that it is not practical for us in the ED.
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6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)
Karl T., M.D. - June 16, 2019 10:06 AM
Tell me you didn’t just recommend getting an MRI on every wrist injury we see.
Jan S. - June 19, 2019 3:09 PM
Not the recommendation for sure! We said that for scaphoid fractures, plain films are not that sensitive (meaning that there is a significant false negative rate). That is why we immobilize those patients where our clinical suspicion for fracture is high and refer them as outpatients to their PMD or to ortho where they will get another round of examination and imaging down the line. Despite the poor test characteristics of plain films, we still start with them in the ED because when they are positive, we have our diagnosis! We talked about the fact that MRI is a better test than plain film for ruling in (or out) scaphoid fracture, but we mentioned that it is not practical for us in the ED.