1695 Which clinical features best predict occult scaphoid fracture? A systematic review and meta-analysis

Aims, Objectives and Background Scaphoid fractures require early identification to avoid complications such as painful non-union, avascular necrosis, chronic wrist pain. Unfortunately, plain radiographs are insufficiently sensitive so patients may immobilisation further imaging (e.g. MRI) despite normal initial radiographs. The aim of this systematic review was determine which clinical features best predict the presence an occult scaphoid fracture that warrants imaging. Method Design A diagnostic test accuracy studies undertaken. All study designs were included if they evaluated predictors amongst with Quality assessment undertaken using Assessment Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Depending on number studies, data presented individual points, ranges, or meta-analysed by fitting either univariate random effects multi-level mixed logistic regression models. Results Conclusion Eight reported 1,685 injuries. prevalence 7.3%. most accurate pain supination against resistance (sensitivity 100%, specificity 97.9%, LR 45.0 [95% CI 6.5–312.5], strength <10% contralateral side 84.6%, 76.9%, 3.7 2.2–6.1]), ulnar deviation 55.2%, 76.4%, 2.3 1.8–3.0]), pronation 69.2%, 64.6%, 2.0 1.2–3.2]). absence anatomical snuffbox tenderness significantly reduced likelihood „(sensitivity 92.1, 48.4, LR- 0.2 0.4–0.7]). In conclusion, no single feature can satisfactorily exclude fracture. However, a findings affect pre-test Future work should whether combinations be used guide