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> 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. Well, quite. Did you read on? I said: I think that both the sensitivity and specificity are too poor for this to be useful (the sample size is sadly far too small, of course, and the power calculations cannot be right) but we do need to think more about diagnostics than plain film. Rowley Cottingham. Consultant in Emergency Medicine.