why this blog?

Likelihood Ratio (LR) in Emergency Medicine


Diagnosis of scaphoid fractures.
 Are plain radiographs reliable?

Clinical Scenario

It’s a busy wednesday morning in ED. 
A 18 yo guy presents with the right hand upraised and dressed. 
In the other hand he has a bundle of X ray.   
“About ten days ago, it was a Saturday night, I was with my new girl-friend. Hitting a punch bag as hard as possible I felt pain to my right wrist. My doctor ordered wrist X ray. It’s not broken, he says, but I’m very afraid, when I move the wrist  it pains me so much”.
On clinical examination there is snuff box tenderness, the axial loading maneuvre on the thumb is positive (see previous post). 
The emergency phisician takes an accurately look at the X rays. They are of high quality, the study had 4 views of the scaphoid, there’s no evidence of irregularity of cortex, the scaphoid fat pad seems normal.
“Repeat X-ray” orders the doctor….