Costs analysis and comparison of usefulness of acute MRI and 2 weeks of cast immobilization for clinically suspected scaphoid fractures

Abstract

Background and purpose — Fractures of the scaphoid are often not detected on initial plain radiographs. Conventional management of clinically suspected scaphoid fractures is cast immobilization for 2 weeks and then reassessment. Early MRI is a diagnostic alternative. We compared the cost and usefulness of the early MRI diagnostic strategy with that of conventional management.

Patients and methods — This prospective pseudo-randomized study included patients between 18 and 49 years of age who attended Bergen Accident and Emergency Department, Bergen, Norway during 1 year in 2009–2010, after sustaining an acute wrist trauma in the previous week and with a clinically suspected scaphoid fracture. 61 patients were investigated with acute MRI, while 63 patients received standard treatment as a control group. We used cost-minimization analysis to estimate the cost of the 2 patient groups.

Results — Concerning cost, there were no statistically significant differences in the total direct medical costs or in indirect costs between the groups. Concerning usefulness, patients in the MRI group without a fracture (n = 35) used a cast for fewer days (mean 1 day) than patients in the control group with no fractures (n = 52) (mean 14 days; p < 0.001). They had less than half the number of days on sick leave than patients in the control group (mean 7 days vs. 15 days; p = 0.002).

Interpretation — In a Norwegian setting, an early MRI was of value in patients with clinically suspected scaphoid fracture and normal plain radiographs.

Conception and design of the study: THB, KS, TL, LAS, SVB, LL, SAL, and CB. Acquisition of data: THB, KS, LAS, SVB, and CB. Analysis and interpretation of data: THB, KS, TL, LAS, SVB, LL, SAL, and CB. Drafting of the article: THB. Critical revision for important intellectual content: KS, TL, LAS, SVB, LL, SAL, and CB. Final approval of the version to be submitted: THB, KS, TL, LAS, SVB, LL, SAL, and CB. Responsible for the overall content as guarantors: THB and CB.

We thank the staff of Bergen Accident and Emergency Department, including Frank van Betten and Arve Strandenes. We are grateful to our colleagues at Bergen Hand Surgery Center: Leiv Hove, Yngvar Krukhaug, Eivind Strandenes, and Rakel Gudmundsdottir. We also thank Mehdi Behzadi of the Department of Radiology, Stavanger University Hospital, Stavanger, Norway for interpretation of the MRIs. Research grants were received from the University of Bergen and the Norwegian Research Council.

No competing interests declared.