Cost-Effectiveness of Immediate MR Imaging Versus Traditional Follow-Up for Revealing Radiographically Occult Scaphoid Fractures

OBJECTIVE: For suspected scaphoid fractures with no radiographic evidence of fracture, treating symptoms with immobilization and radiographic follow-up has long been the standard of care. Modified MR imaging of the wrist is offered at our institution in screening for radiographically occult scaphoid fractures at the time of initial presentation to the emergency department. We show the advantages and comparative costs of this modified protocol versus a traditional protocol. MATERIALS AND METHODS: Our modified protocol consists of coronal thin-section T1-weighted and fast spin-echo T2-weighted MR images with fat saturation. A review of the literature was performed to assess the accuracy of clinical examination, radiography, and other modalities in the evaluation of scaphoid fractures of the wrist. Charges for this procedure are compared with charges for traditional follow-up. RESULTS: Three of four patients with positive results at clinical examination and negative findings on initial radiographs will be needlessly immobilized and monitored. The charges to the patient at our institution for screening MR imaging of the wrist are 770. The total charges to the patient with the traditional protocol, which would not be necessary with screening MR imaging, are 677 or more if a diagnosis is not made at this time. Bone scanning or routine MR imaging is often eventually used. CONCLUSION: Cost analysis at our institution suggests the two protocols are nearly equivalent from a financial standpoint. The loss of productivity for patients who are unnecessarily in casts or splints may be substantial. Screening MR imaging of the wrist in this setting is becoming accepted at our institution in a manner similar to screening MR imaging of the hip.