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Better Evaluation of Wrist Trauma in the ED

January 5, 2010
Written by: , Filed in: Emergency Radiology
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recent British study supports the American practice of using oblique views, in addition to anteroposterior (AP) and lateral views, to evaluate adult wrist injuries in the emergency room. While the American College of Radiology advocates using all three views, up until now British literature hasn’t addressed the issue.

Using AP and lateral views only, three non-radiologist technicians and one radiologist first reviewed 250 wrist injuries. (In the UK, non-radiologists sometimes interpret images.) Roughly a month later, the readers evaluated the injuries again, this time adding oblique views. Five categories, including definite, probable, or no fracture, were used for injury classification. During the second round the readers couldn’t check their earlier interpretations, and the order of films was randomly mixed.

The results? Adding the oblique views increased the total number of fractures by more than 4 percent. Negative interpretations decreased by 1.2 percent. Of the 250 reports, 53 initially read as “negative” were changed to “definite fracture” after adding the oblique views.

“[The study authors] have addressed an important issue for radiologists worldwide,” says Rahul Pawar, MD, in a review of the study. While adding oblique views increases the amount of radiation a patient receives, the additional images make for a more accurate diagnosis, Pawar notes.


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