Independent validation of the Clinical Scaphoid Score (CSS)
Research type
Research Study
Full title
Independent validation of the Clinical Scaphoid Score (CSS) for suspected scaphoid fractures with normal plain radiographs
IRAS ID
229416
Contact name
Arvind Mohan
Contact email
Sponsor organisation
Croydon University Hospitals NHS Trust
Duration of Study in the UK
0 years, 8 months, 1 days
Research summary
Occult scaphoid fractures are present in between 8.4% (Bergh et al. 2014) to 16% (Hunter et al. 1997) of cases of clinically suspected fracture with normal plain radiographs. Recent NICE (National Institute for Clinical Excellence) guidelines have recommended MRI (Magnetic Resonance Imaging) as first line investigation when plain radiographs are negative for suspected scaphoid fractures.
From our initial pilot data at Croydon University Hospital we know that 30 patients per month are referred for scaphoid radiographs with the majority being normal. Approximately 8 patients per month are referred onwards for MRI scans; an investigation that is currently requested at the fracture clinic visit normally 1-2 weeks after the initial injury. If the NICE guidelines were applied to all patients with suspected scaphoid fracture this would potentially triple the number of MRI scans per month. This is potentially unsustainable.
There is a validated scoring system that uses 3 clinical examination findings to help triage high and low risk patients (Bergh et al. 2014). We would aim to use this as the basis of a triage system to help identify 2 groups:
1. low risk that could be immobilised with a plaster cast and seen in fracture clinic after 2 weeks (usual care)
2. high risk that could be immobilised with a plaster cast and sent for an early MRI scan via the virtual fracture clinic.
The validity of the cut off values between low and high risk would be evaluated using ROC (Receiver Operating Characteristics) curve analysis. The impact of a 4th clinical finding to the score would also be evaluated to determine if it can improve the validity of the overall score.
This will help us meet NICE guidelines whilst appropriately rationing the service to those who need the MRI scan and minimising the risk of missed diagnoses.
REC name
West Midlands - Black Country Research Ethics Committee
REC reference
17/WM/0335
Date of REC Opinion
7 Sep 2017
REC opinion
Further Information Favourable Opinion