Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid XXXX .

@entity1 @entity174
OBJECTIVE: For suspected scaphoid @entity174 with no radiographic evidence of @entity174 , 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 @entity174 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 @entity174 of the wrist. Charges for this procedure are compared with charges for traditional follow-up. RESULTS: Three of four @entity1 with positive results at clinical examination and negative findings on initial radiographs will be needlessly immobilized and monitored. The charges to the @entity1 at our institution for screening MR imaging of the wrist are  770. The total charges to the @entity1 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 @entity1 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.
