Outcome of wrist injuries with clinical suspicion of scaphoid injury after normal computed tomography

Objectives Wrist injuries are a common presentation to emergency departments. A clinical pathway has recently been introduced in our institution for patients with clinical suspicion of a scaphoid injury, using computed tomography (CT) at 2 weeks postinjury to rule out scaphoid fracture. However, it is not known what happens to patients who have a normal CT after such an injury. The aim of this pilot study was to assess disability after CT-negative wrist injuries. Methods A prospective questionnaire study was undertaken to assess disability in patients who had a normal CT after clinical suspicion of a scaphoid fracture, using the Patient Rated Wrist Evaluation questionnaire. Adult patients were recruited at their first emergency department clinic review, where a baseline questionnaire was completed. Follow-up questionnaires were sent 3, 6 and 12 months later. Pain and function were assessed on a 0-10 scale, giving a total score out of 100. Results Ninety-nine patients were initially recruited, of whom 72 had negative CT; 40 patients completed follow-up. There was a statistically significant reduction in pain, functional deficit and combined disability between baseline scores and 12-month follow-up. Overall, three (8%) patients had severe disability (pain and function combined), and six (15%) had moderate disability at 12 months. Conclusion The majority of these patients recover from their injury, but a small proportion with normal CT scans have considerable disability 12 months after injury. Appropriate advice should be given to these patients to enable them to access further investigation and treatment. European Journal of Emergency Medicine 19: 188-192 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.