scholarly journals RELATIONSHIP BETWEEN PARENTAL AGE AND SEVERITY OF OROFACIAL CLEFTS

2021 ◽  
Author(s):  
Olawale Adamson ◽  
Abimibola V. Oladugba ◽  
Azeez Alade ◽  
Waheed O. Awotoye ◽  
Tamara Busch ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Maxillofacial Surgery ◽  
Paternal Age ◽  
University Teaching ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Parental Age ◽  
Orofacial Clefts ◽  
Young Fathers ◽  
Increased Risk

ABSTRACTOBJECTIVESThis study aims to investigate the relationship between paternal age, maternal age, and both on the severity of orofacial clefts.DESIGNThis was a retrospective study of cases which were subjects clinically diagnosed with non-syndromic cleft lip and/or palate (CL/P). Data was obtained from the AFRICRAN project database on Nigerian non-syndromic orofacial cleft cases.SETTINGThe samples for cases in this study were obtained at the Cleft clinic of Oral and Maxillofacial surgery at the Lagos University Teaching Hospital, Lagos.OUTCOMEPrimary outcome measure is severity of orofacial clefts and secondary outcome measure is to evaluate the effect of parental age in determining the incidence of left or right sided orofacial clefts.RESULTSThere is no statistical significant association between type of CL ± P and parental age in young fathers (p=0.93). When old fathers are considered, percentage of complete (more severe) CL ± P cases increases especially in old mothers and this was statistically significant (p=0.036). In old fathers, the risk of CL ± P is increased (OR: 2.66, CI: 1.04-6.80) and also there is increased risk of developing right sided CL ± P (OR: 1.61, CI: 1.0-2.59). There is reduced risk of isolated cleft palate in young fathers (OR: 0.36, CI: 0.07-1.71) but the risk increases when considering complete types (more severe) of isolated cleft palates (OR: 1.63, CI: 0.71-3.7)CONCLUSIONThe study shows a higher risk of CL ± P is associated with increase father’s age.

scholarly journals Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

2018 ◽  
Vol 103 (10) ◽  
pp. 1395-1400 ◽  
Author(s):  
Rashmi G Mathew ◽  
Sahar Parvizi ◽  
Ian E Murdoch
Keyword(s):  
Cataract Surgery ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Risk Of Failure ◽  
Increased Risk ◽  
Significant Difference ◽  
Measure Change ◽  
Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

scholarly journals Agreement between capillary and venous lactate in emergency department patients: prospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026109 ◽  
Author(s):  
Colin A Graham ◽  
Ling Yan Leung ◽  
Ronson SL Lo ◽  
Kwok Hung Lee ◽  
Chun Yu Yeung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Blood Lactate ◽  
Prospective Observational Study ◽  
Outcome Measure ◽  
Capillary Blood ◽  
University Teaching ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Blood Gas

ObjectivesCapillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the reference venous level assessed using a point-of-care testing (POCT) blood gas analyser (VL-Ref).DesignA prospective observational study.SettingA university teaching hospital emergency department in Hong Kong.ParticipantsPatients triaged as ‘urgent’ (Category 3 of a 5-point scale), aged ≥18 years during 2016 were eligible. 240 patients (mean age 69.9 years) were recruited.Primary and secondary outcome measuresThe primary outcome measure was the agreement of the capillary blood lactate level measured by handheld lactate analyser when compared with the reference standard technique, namely venous blood samples obtained by venepuncture and analysed using the blood gas analyser. The secondary outcome measure was the difference in values of venous lactate using blood gas analysers and handheld lactate analysers.ResultsThe results of VL-Ref ranged from 0.70 to 5.38 mmol/L (mean of 1.96 mmol/L). Regarding capillary lactate measurements, the bias (mean difference) between VL-Ref and CL-Scout+ was −0.22 with 95% limits of agreement (LOA) of −2.17 to 1.73 mmol/L and the bias between VL-Ref and CL-Nova was 0.46, with LOA of −1.08 to 2.00 mmol/L. For venous lactate, results showed the bias between VL-Ref and VL-Scout+ was 0.22 with LOA being −0.46 to 0.90 mmol/L, and the bias between VL-Ref and VL-Nova was 0.83 mmol/L with LOA −0.01 to 1.66 mmol/L.ConclusionOur study shows poor agreement between capillary lactate and reference values. The study does not support the clinical utility of capillary lactate POCT. However, venous lactate measured by Scout+ handheld analyser may have potential for screening patients who may need further testing.Trial registration numberNCT02694887.

scholarly journals P585 Evaluation and comparison of the safety profiles of different intravenous iron preparations and oral iron for treatment of iron deficiency anaemia: Preliminary results from the IBD subgroup analysis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S490-S490 ◽  
Author(s):  
A Aksan ◽  
H Işık ◽  
S Aksan ◽  
D Tuğal ◽  
A Dignass ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Outcome Measure ◽  
Oral Iron ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Preliminary Results ◽  
Increased Risk ◽  
Statistical Heterogeneity ◽  
Iv Iron

Abstract Background Current ECCO guidelines state that intravenous (IV) iron should be considered first-line treatment in patients with clinically active IBD, previous intolerance to oral iron, Hb below 100 g/l and patients who need erythropoiesis-stimulating agents. Several different IV iron products are available with differing therapeutic effectiveness and tolerability. In this ongoing study, we compare their safety profiles to establish whether any IV iron carries an increased risk compared with other IV iron products or with oral iron, and to determine which, if any, has a superior safety profile. We report preliminary results from an IBD subgroup analysis. Methods We performed a systematic review and network meta-analysis (NMA), searching PUBMED, SCOPUS, WoS and Cochrane Library up to July 2019. The primary outcome measure was the pooled total of drug-related adverse events (AEs) and serious AEs (SAEs) in proportion to the safety population. The secondary outcome measure was identification of the most common AEs. Results 8086 distinct publications were found. Of 171 relevant full-text articles on IBD, 5 RCTs (n = 1143) were eligible. Bayesian NMA was performed using a fixed effects model. Low statistical heterogeneity was determined (I2= 9%). AE rates did not differ significantly between the different IV iron products (ferric carboxymaltose/FCM; iron sucrose/IS; iron isomaltoside/IIM) or oral iron. Compared with oral iron; OR=0.69, 95% CrI [0.29;1.7] for FCM, OR=0.52, 95% CrI [0.22;1.2] for IS, OR=1.5, 95%CrI [0.80;3.1] for IIM. Compared with FCM; OR=0.74, 95% CrI [0.45;1.2] for IS, OR=2.2, 95% CrI [0.74;6.7] for IIM. Compared with IS; OR=0.1.3, 95% CrI [0.82;2.2] for IS, OR=3.0, 95% CrI [1.0;9.1] for ISM. Compared with IIM; OR=0.45, 95% CrI [0.15;1.3] for FCM, OR=0.33, 95% CrI [0.11;1.0] for IS. The most common AEs were headache (1.8%) and transient hyperferritinaemia (1.8%) for FCM; headache (1.5%), hyperferritinaemia and rigors (both 1.2%) for IS; flushing (2.7%), hypersensitivity and hepatic enzyme increase (both 1.8%) for IIM; diarrhoea (8.0%) and abdominal pain (7.7%) for oral iron. Hypophosphataemia was reported in only 1 RCT of FCM, here transient and clinically asymptomatic. Seven SAEs were recorded; 1/381 for FCM, 1/223 for IIM and 5/238 for oral iron. Conclusion None of the IV iron products was associated with an increased risk of AEs or SAEs compared with oral iron and all showed similarly low rates of AEs. However, their safety profiles differed: Whereas with FCM or IS, headaches were most commonly reported, IIM was more frequently associated with hypersensitivity reactions or increase in hepatic enzymes. On this evidence, while FCM, IS and IIM are all safe, their differing safety characteristics should be considered in therapeutic decision-making.

scholarly journals Impact of neighbourhood walkability on the onset of multimorbidity: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e045890
Author(s):  
John Sina Moin ◽  
Richard H Glazier ◽  
Kerry Kuluski ◽  
Alex Kiss ◽  
Ross Upshur
Keyword(s):  
Chronic Conditions ◽  
Outcome Measure ◽  
Population Level ◽  
Cost Of Care ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Walkability Index ◽  
Neighbourhood Walkability ◽  
Increased Risk ◽  
Study Results

Multimorbidity has become highly prevalent around the globe and been associated with adverse health outcomes and cost of care. The built environment has become an important dimension in response to obesity and associated chronic diseases by addressing population sedentariness and low physical activity.ObjectiveThe aim of the following study was to examine whether there was an increased risk for multimorbidity for those living in less walkable neighbourhoods. It was hypothesised that participants residing in less walkable neighbourhoods would have a higher risk for multimorbidity.SettingCity of Toronto and 14 neighbouring regions/municipalities within Ontario, Canada.ParticipantsStudy participants who had completed the Canadian Community Health Survey between the year 2000 and 2012, between 20 and 64 and 65 and 95 years of age, residing within a neighbourhood captured in the Walkability Index, and who were not multimorbid at the time of interview, were selected.InterventionThe Walkability Index was the key exposure in the study, which is divided into quintiles (1—least, 5—most walkable neighbourhoods). Participants were retrospectively allocated to one of five quintiles based on their area of residency (at the time of interview) and followed for a maximum of 16 years.Primary outcome measureBecoming multimorbid with two chronic conditions.Secondary outcome measureBecoming multimorbid with three chronic conditions.ResultsRisk for multimorbidity (two chronic conditions) was highest in least compared with most walkable neighbourhoods with an HR of 1.14 (95% CI: 1.02 to 1.28, p=0.0230). While results showed an overall gradient response between decreased walkability and increased risk for multimorbidity, they were not statistically significant across all quintiles or in the older-adult cohort (65–95 years of age).ConclusionStudy results seem to suggest that low neighbourhood walkability may be a risk factor for multimorbidity over time. More studies are needed to examine whether neighbourhood walkability is a potential solution for multimorbidity prevention at the population level.

scholarly journals Biceps Tenodesis versus Tenotomy at the Time of Manipulation and Lysis of Adhesions for Adhesive Capsulitis

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0038
Author(s):  
Jourdan M. Cancienne ◽  
James E. Christensen ◽  
David R. Diduch ◽  
Stephen F. Brockmeier ◽  
Brian C. Werner
Keyword(s):  
Outcome Measure ◽  
Adhesive Capsulitis ◽  
Secondary Outcome ◽  
Categorical Variables ◽  
Secondary Outcome Measure ◽  
Biceps Tenodesis ◽  
Biceps Tenotomy ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Square Analysis

Objectives: Although rare in the treatment of adhesive capsulitis, arthroscopic lysis of adhesions and manipulation under anesthesia (LOA/MUA) may be necessary if the patient fails conservative therapy. Patients at the time of surgery often have biceps tendon, superior labrum anterior to posterior (SLAP) pathology, or other pathology requiring concurrent treatment. Common treatments for these can include biceps tenodesis or tenotomy. Some surgeons believe that concomitant repairs at the time of LOA/MUA can cause increased stiffness post-operatively due to need for immobilization or protection, possibly leading to poorer outcomes and potentially needing further interventions such as repeat injections or repeat LOA/MUA. The goal of this study was to compare patients who underwent LOA/MUA with biceps tenodesis to those who underwent LOA/MUA with biceps tenotomy. We hypothesized that biceps tenodesis at the time of LOA/MUA did not lead to an increased risk for further intervention in the form of post-operative injections for pain or stiffness or repeat LOA/MUA compared to biceps tenotomy. Methods: A retrospective review of consecutive LOA/MUA for adhesive capsulitis performed by 5 surgeons at a single center from 2010-2016 was performed. All included patients were required to have a minimum of 1 year of follow-up, and be a minimum 2 years post-procedure. Exclusion criteria included prior biceps tenodesis, surgery within six months prior to LOA/MUA, prior infection, prior shoulder fracture or fracture fixation, and concomitant rotator cuff repair. Patients without any biceps surgery (tenotomy or tenodesis) were also excluded. The primary outcome measure was a postoperative injection in the ipsilateral shoulder for recurrent adhesive capsulitis, pain or residual stiffness. The secondary outcome measure was a repeat LOA/MUA. Statistical analysis was completed in SPSS using a chi-square analysis for categorical variables and a student’s t-test for continuous variables. Results: Fifty-five patients were included in the study. Thirty-three patients underwent biceps tenotomy, and 22 patients underwent biceps tenodesis at the time of arthroscopic LOA/MUA. The average age in the tenotomy group was 53 years and 47 years in the tenodesis group (p = 0.383). There was no significant difference in the percentage of males in the tenodesis group (59%) versus tenotomy (48%) (p = 0.440). Average body mass index (BMI) was not significantly different between the two groups (p = 0.329). No patients from either group underwent repeat LOA/MUA. Of those patients who received a biceps tenotomy, 39% had an injection for pain or stiffness post-operatively compared to 18% for biceps tenodesis, which was not significant (p=0.17). Table 1 summarizes the outcomes in both groups. Conclusion: Patients who underwent biceps tenodesis with concurrent arthroscopic LOA/MUA for adhesive capsulitis did not have a higher rate of postoperative injections or repeat LOA/MUA compared to patients who underwent biceps tenotomy at the time of LOA/MUA. [Table: see text]

scholarly journals Determinants of Sports Injury in Young Female Swedish Competitive Figure Skaters

2021 ◽  
Vol 3 ◽  
Author(s):  
Moa Jederström ◽  
Sara Agnafors ◽  
Christina Ekegren ◽  
Kristina Fagher ◽  
Håkan Gauffin ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Sports Injury ◽  
Young Female ◽  
Older Age ◽  
Point Prevalence ◽  
Severe Injury ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Multiple Model ◽  
Figure Skaters

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants.Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss >21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits.Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1–1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2–1.7; p < 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.049).Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.

The importance of perioperative optimisation to facilitate safe regional anaesthesia and their improved outcomes in fracture neck of femur patients

2021 ◽  
pp. 175045892110640
Author(s):  
Benjamin Thomas Vincent Gowers ◽  
Michael Sean Greenhalgh ◽  
Kathryn Dyson ◽  
Karthikeyan P Iyengar ◽  
Vijay K Jain ◽  
...  
Keyword(s):  
Hip Fracture ◽  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
General Anaesthetic ◽  
Secondary Outcome Measure ◽  
Neck Of Femur ◽  
One Year ◽  
To Receive

Background: Hip fractures are common presentations to orthopaedic departments, and their surgical management often results in blood transfusions. Compared with general anaesthesia, regional anaesthesia reduces the need for transfusions and mortality in the wider surgical population. Aims: In hip fracture patients, our primary outcome measure was to examine any relationship between anaesthetic modality and transfusion rates. The secondary outcome measure was to assess the relationship between anaesthetic modality and one-year mortality. Methods: A retrospective cohort study of 280 patients was carried out in 2017 and 2018. Data were collected from patient records, local transfusion laboratory and the national hip fracture database. Results: A total of 59.6% had regional and 40.4% general anaesthesia. Regional anaesthesia patients were younger with fewer comorbidities (p < .05). About 19.8% regional and 34.5% general anaesthesia patients received transfusions (odds ratio (OR) = 0.47, p < .05); 13.6% were taking anticoagulants and were less likely to receive a regional anaesthetic (31.6% versus 64%, OR = 0.26, p < .05). One-year mortality was 27% for regional and 37% for general anaesthetic patients (OR = 0.64, p = .09). Conclusion: Regional anaesthesia halved the risk of blood transfusion. Anticoagulated patients were 74% less likely to receive regional anaesthetics, but had no additional transfusion risk. With optimisation, a larger proportion of patients could have regional anaesthesia.

scholarly journals Impact of blood group on survival following critical illness: a single-centre retrospective observational study

2019 ◽  
Vol 6 (1) ◽  
pp. e000426
Author(s):  
Robert Slade ◽  
Raza Alikhan ◽  
Matt P Wise ◽  
Lam Germain ◽  
Simon Stanworth ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Blood Group ◽  
Outcome Measure ◽  
Tertiary Hospital ◽  
Current Data ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Transfusion Requirements ◽  
Significant Difference

BackgroundPredicting patient outcomes following critical illness is challenging. Recent evidence has suggested that patients with blood group AB are more likely to survive following major cardiac surgery, and this is associated with a reduced number of blood transfusions. However, there are no current data to indicate whether a patient’s blood group affects general intensive care outcomes.ObjectiveThe objective of this study was to determine if ABO blood group affects survival in intensive care. The primary outcome measure was 90-day mortality with a secondary outcome measure of the percentage of patients receiving a blood transfusion.DesignRetrospective analysis of electronically collected intensive care data, blood group and transfusion data.SettingGeneral intensive care unit (ICU) of a major tertiary hospital with both medical and surgical patients.PatientsAll patients admitted to ICU between 2006 and 2016 who had blood group data available.InterventionNone.Measurements and main results7340 patients were included in the study, blood group AB accounted for 3% (221), A 41% (3008), B 10.6% (775) and O 45.4% (3336). These values are similar to UK averages. Baseline characteristics between the groups were similar. Blood group AB had the greatest survival benefit (blood group AB 90-day survival estimate 76.75, 95% CI 72.89 to 80.61 with the overall estimate 72.07, 95% CI 71.31 to 72.82) (log-rank χ2 16.128, p=0.001). Transfusion requirements were similar in all groups with no significant difference between the percentages of patients transfused (AB 23.1%, A 21.5%, B 18.7%, O 19.9%, Pearson χ2 5.060 p=0.167).ConclusionAlthough this is primarily a hypothesis generating study, intensive care patients with blood group AB appeared to have a higher 90-day survival compared with other blood groups. There was no correlation between blood group and percentage of patients receiving transfusion.

Stratification of chronic and complex wounds according to healing characteristics: a retrospective study

2019 ◽  
Vol 28 (7) ◽  
pp. 446-452
Author(s):  
Nicole E. Spruijt ◽  
Maarten M. Hoogbergen ◽  
Servaas J.E. Buijs ◽  
Marcel J.W. Grosveld ◽  
Jaap Buth
Keyword(s):  
Wound Healing ◽  
Retrospective Study ◽  
Outcome Measure ◽  
Treatment Time ◽  
Wound Dehiscence ◽  
Lower Percentage ◽  
Secondary Outcome ◽  
Study Cohort ◽  
Secondary Outcome Measure ◽  
Risk Categories

Objective: Wound risk-stratified analyses are clinically relevant as they can assist in identifying hard-to-heal wounds. The aim of the study is to develop risk categories for wound healing based on a limited number of reliably recordable clinical data. Method: This retrospective study used observational data. The primary outcome measure was wound healing at the end of treatment and the secondary outcome measure was the time to wound healing. A stratification model using regression analyses was developed to assign the patients to risk categories for wound healing and the time-to-heal. Results: The study cohort comprised of 540 patients. The most common wound diagnoses were diabetic ulcers, wounds in irradiated areas and wound dehiscence after surgery. Average wound duration before starting treatment at the wound centre was 11.7 months. Healing was achieved in 382 (71%) wounds, after an average treatment time of 4.4 months. A total of four risk categories for wound healing were developed by combining wound diagnosis (favourable versus unfavourable) and duration (<3 months versus >3 months). These risk categories demonstrated healing percentages ranging from 69–97% (p=0.0004) and mean time-to-healing varying from 2.7–5.9 months (p=0.01). Conclusion: Using two clinical wound variables, diagnosis and duration, stratification categories were identified with significant associations with wound healing outcomes. Longer wound duration and unfavourable diagnoses, when combined into unfavourable risk categories, were associated with a lower percentage of wound healing and a longer treatment time until healing.

Reliability of clinical tests for prediction of occult scaphoid fractures and cost benefit analysis of a dedicated scaphoid pathway

2020 ◽  
pp. 175319342097946
Author(s):  
Preetham Kodumuri ◽  
Andrew McDonough ◽  
Victoria Lyle ◽  
Zaf Naqui ◽  
Lindsay Muir
Keyword(s):  
Outcome Measure ◽  
Cost Benefit Analysis ◽  
Scaphoid Fracture ◽  
Cost Benefit ◽  
Clinical Suspicion ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Post Injury ◽  
Level Of Evidence ◽  
Scaphoid Fractures

We reviewed the outcomes of our dedicated clinic for suspected scaphoid fractures. The primary outcome measure was to test the reliability of accurately diagnosing an occult scaphoid fracture with a combination of anatomical snuff box, scaphoid tubercle, longitudinal compression tenderness, ulnar deviation and the pinch test. Cost savings of the new patient pathway was our secondary outcome measure. Between December 2016 and March 2020, 922 patients were recruited at a mean of 12 days post-injury. Sixty-five per cent ( n = 602) with a low clinical suspicion were discharged and 35% ( n = 320) with a high clinical suspicion had same day MRI scan. Fifty-eight scaphoid fractures were diagnosed and treated with no nonunions reported. Anatomical snuff box tenderness was the most sensitive test (90%). A combination of five tests better excluded an occult fracture (80% accuracy). The dedicated scaphoid clinic pathway resulted in 350 fewer follow-up visits and an overall saving of £59,666. Level of evidence: III

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