Pilot study evaluating a clinical decision tool on suspected scaphoid fractures.

In an earlier study we have proposed a scaphoid decision-protocol in order to improve diagnostic accuracy in case of suspected scaphoid fractures. This pilot study evaluated this protocol. In this pilot study (n = 31) most cases with clinical suspicion of scaphoid fractures reached a positive test result on the combined 7 clinical tests (93.5%). Using this test combination, no scaphoid fractures were missed (no false-negatives; sensitivity 100%), but it also included many patients with no scaphoid fracture. Many of these, however, were found to have another fracture. In total, 48% had a scaphoid fracture, 19% another fracture and 32% no fracture. In the pilot study the proposed protocol seems to be a safe protocol, without missing scaphoid fractures. It leads to a reduction of unnecessary plaster casting of sprained wrists and produces a marked reduction in plain radiographic examinations.