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lüll Management of suspected scaphoid fractures in accident and emergency departments--time for new guidelines Tai CC; Ramachandran M; McDermott ID; Ridgeway S; Mirza ZAnn R Coll Surg Engl 2005[Sep]; 87 (5): 353-7INTRODUCTION: The objectives of this work were to assess the clinical knowledge of clinicians in the accident and emergency (A&E) departments in England & Wales and evaluate the current trend for the acute management of radiologically normal, but clinically suspected, fractures of the scaphoid. SUBJECTS AND METHODS: We conducted a telephone survey on 146 A&E senior house officers (SHOs) in 50 different hospitals. This survey assessed the clinicians' experience, their clinical and radiological diagnostic methods, and their initial treatment of suspected scaphoid fractures. RESULTS: The majority (55.8%) of SHOs performed only one clinical test to diagnose suspected scaphoid fractures. Overall, 41% were unable to cite the number of the radiographic views taken and only 10% of departments have direct access to further radiological investigation. There is wide variation in the early treatment of this injury, with the scaphoid cast used most commonly (46%). The majority of SHOs (89%) were unable to describe the features of immobilisation. The mean follow-up period was 10 days, and 53% of cases were followed-up by the senior staff in A&E. Of SHOs, 54% were not aware of any local guidelines for the management of suspected scaphoid fractures in their departments, and 92% were not aware of the existence of the 1992 British Association for Accident and Emergency Medicine (BAEM) guidelines. CONCLUSIONS: The clinical knowledge and the management of suspected scaphoid fractures in A&E are unsatisfactory. We, therefore, suggest that the dissemination of up-to-date guidelines could help to educate clinicians to provide better care to the patients.|Clinical Competence[MESH]|Emergency Service, Hospital/*statistics & numerical data[MESH]|England[MESH]|Female[MESH]|Fractures, Bone/diagnosis/*therapy[MESH]|Humans[MESH]|Length of Stay[MESH]|Male[MESH]|Medical Staff, Hospital/standards[MESH]|Physical Examination[MESH]|Practice Guidelines as Topic[MESH]|Professional Practice[MESH]|Radiology Department, Hospital/statistics & numerical data[MESH]|Referral and Consultation/statistics & numerical data[MESH]|Scaphoid Bone/*injuries[MESH]|Wales[MESH] |