Of course in this day and age of globilisation what's stopping us getting a radioGRAPHER to do the scan, be that CT/USS or limb coil MRI and sending the image to a hospital elsewhere in the world where it IS 9-5pm and then we can get 24/7 hot reporting. The legal cover could almost certainly be worked through.
Perhaps we could suggest that to cover the cost of this we would retain some of the A&E budget that currently goes to the radiology dept.
Yours (mostly but not entirely with tongue in cheek)
Peter Cutting
---------- Original Message ----------------------------------
From: "Dunn Matthew Dr. (RJC) A & E - SwarkHosp-TR" <[log in to unmask]>
Reply-To: Accident and Emergency Academic List <[log in to unmask]>
Date: Mon, 28 Jun 2004 13:13:11 +0100
>> There is increasing interest in the use of ultrasound with
>> this reported in the last few days:
>>
>> J Hand Surg [Am]. 2004 May;29(3):400-5.
>>
>>
>> "Ultrasound for the early diagnosis of clinically suspected
>> scaphoid fracture.
>>
>> Senall JA, Failla JM, Bouffard JA, van Holsbeeck M.
>> One hand
>> surgeon performed the examination, and ultrasounds were read
>> by a musculoskeletal radiologist.
>> RESULTS: Ultrasound
>> identified correctly 7 of 9 cases that were eventually
>> positive for scaphoid fracture on plain x-ray.
>> Ultrasound was read correctly as negative in 8 of 9
>> x-ray-negative cases; this was statistically
>> significant. The 1 false-positive case had radioscaphoid
>> arthrosis and radial wrist swelling.
>> Sensitivity was 78% and specificity was 89%. The positive
>> predictive value was 88% and negative
>> predictive value was 80%. CONCLUSIONS: We recommend that
>> high-frequency ultrasound be
>> used to investigate occult suspected scaphoid fractures
>> because of its ability to allow early
>> diagnosis and to eliminate the need for a more invasive or
>> expensive diagnostic test in most cases."
>
>
>Missing 2 out of 9 fractures seems quite a lot, and doesn't mean you can
>avoid POP. And specificity is too low for it to be used as a "rule in". An
>important issue is that these were all read by a musculoskeletal
>radiologist. Great if you've got one handy. As it stands we've got a paper
>showing that if you've got the resources ( and what's the chances of
>getting a radiologist to do this either as a "one stop" clinic with a
>clinician or by seeing the patients themselves and discharging those without
>asb tenderness), then you still don't have accurate enough information to
>safely change your clinical management. Or am I reading it wrong?
>What I'd like to see would be a paper showing ultrasound by an EP could
>reliably exclude scaphoid fracture at initial presentation (which is
>unlikely give the unreliability of the technique in this small study). If
>all patients could be scanned at the point of presentation (or next working
>day if there was nobody with relevant ultrasound skills in the department)
>and discharged if negative rather than getting a POP on in the first place,
>that would be useful.
>
>Matt Dunn
>Warwick.
>
>
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