Clinical Scaphoid Score (CSS) of Bergh et al for Ordering an MRI on a Patient with Wrist Trauma and a Normal X-Ray

Description

Bergh et al developed a clinical scaphoid score (CSS) for evaluating a patient with wrist trauma and a normal wrist X-ray. This can help to decide if an MRI should be ordered to detect a scaphoid fracture. The authors are from Bergen Emergency Department (Norway), Stavanger University and Royal Derby Hospital.

Patient selection: wrist trauma with negative X-ray

Parameters:

(1) tenderness in the anatomical snuffbox with the wrist in ulnar deviation

(2) tenderness over the scaphoid tubercle

(3) pain upon longitudinal compression of the thumb

Parameter	Finding	Points
tenderness in the anatomical snuffbox	absent	0
	present	3
tenderness over the scaphoid tubercle	absent	0
	present	2
pain on longitudinal compression of thumb	absent	0
	present	1

total score =

= SUM(points for all 3 parameters)

Interpretation:

• minimum score: 0

• maximum score: 6

• A patient with a score >= 4 should have a wrist MRI.

• A score of >= 4 is equivalent to the first parameter AND one or both of the other 2.

Performance:

• A score < 4 has a negative predictive value of 96%.

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Clinical Scaphoid Score (CSS) of Bergh et al for Ordering an MRI on a Patient with Wrist Trauma and a Normal X-Ray

Description

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