Comparison of three different methods to estimate the burden of disease of burn injuries in Western Australia in 2011-2018.

BACKGROUND: Priority setting and resource allocation in health care, surveillance and interventions is based increasingly on burden of disease. Several methods exist to calculate the non-fatal burden of disease of burns expressed in years lived with disability (YLDs). The aim of this study was to assess the burden of disease due to burns in Western Australia 2011-2018 and compare YLD outcomes between three existing methods. METHODS: Data from the Burns Service of Western Australia was used. Three existing methods to assess YLDs were compared: the Global Burden of Disease (GBD) method, a method dedicated to assess injury YLDs (Injury-VIBES), and a method dedicated to assess burns YLDs (INTEGRIS-burns). RESULTS: Incidence data from 2,866 burn patients were used. Non-fatal burden of disease estimates differed substantially between the different methods. Estimates for 2011-2018 ranged between 610 and 1,085 YLDs per 100.000 based on the Injury-VIBES method; between 209 and 324 YLDs based on the INTEGRIS-burns method; and between 89 and 120 YLDs based on the GBD method. YLDs per case were three to nine times higher when the Injury-VIBES method was applied compared to the other methods. Also trends in time differed widely through application of the different methods. There was a strong increase in YLDs over the years when the Injury-VIBES method was applied, a slight increase when the INTEGRIS-burns method was applied and a stable pattern when the GBD method was applied. CONCLUSION: This study showed that the choice for a specific method heavily influences the non-fatal burden of disease expressed in YLDs, both in terms of annual estimates as well as in trends over time. By addressing the methodological limitations evident in previously published calculations of the non-fatal burden of disease, the INTEGRIS-burns seems to present a method to provide the most robust estimates to date, as it is the only method adapted to the nature of burn injuries and their recovery.

Damage of the distal radial physis in young gymnasts: can three-dimensional assessment of physeal volume on MRI serve as a biomarker?

OBJECTIVE: To explore the use of quantitative volume assessment to identify the presence and extent of stress-related changes of the distal radial physis in gymnasts with suspected physeal injury, asymptomatic gymnasts, and non-gymnasts. METHODS: Symptomatic gymnasts with clinically suspected distal radial physeal injury, asymptomatic gymnasts, and non-gymnasts (n = 69) were included and matched on skeletal age and sex. Volume measurements were performed on coronal water selective cartilage MRI images by creating three-dimensional physeal reconstructions semi-automatically using active-contour segmentation based on image-intensity thresholding. Inter- and intra-rater reliability of the measurements were assessed using intra-class correlation coefficients (ICC) for absolute agreement. RESULTS: Twenty-seven symptomatic-, 18 asymptomatic-, and 24 non-gymnasts were included with a median age of 13.9 years (interquartile range (IQR) 13.0-15.0 years). Median physeal volume was significantly increased (p < 0.05) in symptomatic- (971 mm3, IQR 787-1237 mm3) and asymptomatic gymnasts (951 mm3, IQR 871-1004 mm3) compared with non-gymnasts (646 mm3, IQR 538-795 mm3). Inter-rater (ICC 0.96, 95% CI 0.92-0.98) and intra-rater (ICC 0.93, 95% CI 0.85-0.97) reliability of volume measurements were excellent. Of the 10 participants with the highest physeal volumes, nine were symptomatic gymnasts. CONCLUSION: Increased volume of the distal radial physis can reliably be assessed and is a sign of physeal stress that can be present in both symptomatic- and asymptomatic gymnasts, but gymnasts with suspected physeal injury showed larger volume increases. Future studies should explore if volume assessment can be used to (early) identify athletes with or at risk for physeal stress injuries of the wrist. KEY POINTS: • The volume of the distal radial physis can be reliably assessed by creating three-dimensional physeal reconstructions. • Stress-related volume increase of the distal radial physis is present in symptomatic and asymptomatic gymnasts. • Gymnasts with clinically suspected physeal injury showed larger volume increases compared with asymptomatic gymnasts and may therefore be a valuable addition in the (early) diagnostic workup of physeal stress injuries.

Cost description of clinical examination and MRI in wrist ligament injuries.

OBJECTIVE: The total number and cost of wrist MRIs in the catchment area of the Västra Götaland Region in Sweden (population 1 723 000) during 1 year was analysed, together with the number and content of referrals. METHODS: Six radiology departments reported the numbers and rate of all MRI investigations intended to diagnose wrist ligament injuries (n = 411) and other injuries to the wrist. RESULTS: The additional cost of the difference between MRIs and a clinical examination by a hand surgeon, plus indirect costs for patients with suspected wrist ligament injuries, was calculated as 957 000 euros. CONCLUSIONS: It is recommended that MRI should only be used in patients in whom there are clinical difficulties in terms of diagnosing wrist ligament injuries. It is suggested that patients with suspected wrist ligament injuries should be referred directly to an experienced hand surgeon, capable of performing a standardised wrist examination and, when needed, diagnostic arthroscopy and final treatment. The proposed algorithm for the diagnosis and treatment of suspected wrist ligament injuries presented in the present study could save time for the patient and for the radiology departments, as well as reducing costs. The ability to implement the early and appropriate treatment of acute ligament injuries could be improved at the same time.

Review of MRI wrist examination since introduction of Medicare item number.

INTRODUCTION: The Australian Health Department provided extended rebatable requesting rights to general practitioners in 2012 for magnetic resonance imaging (MRI) examinations in patients less than 16 years of age for a small set of clinically appropriate indications. Included item numbers 63522 and 63523 'referral by a medical practitioner (excluding a specialist and consultant physician) for a scan of wrist following radiographic examination where scaphoid fracture is suspected'. The aim of this study is to evaluate MRI examinations of suspected scaphoid fractures in the paediatric population following the Medicare item number introduction. METHODS: Review of 60 consecutive MR wrist examinations requested by general practitioners and performed between 30 November 2012 and 16 July 2014 for a rebatable magnet in a private clinical setting. The indication for all studies was to exclude a clinically suspected fractured scaphoid following a normal radiograph. All patients were less than 16 years of age at time of examination. RESULTS: Sixty examinations were performed; 51 revealed pathology (85% of cases) with nine normal examinations (15%). Twenty-nine studies revealed one of more fractures involving the carpals, metacarpals or distal radius. In total, 41 fractures were identified on MRI examination with 29 carpal bone fractures, six distal radius fractures and six metacarpal fractures. CONCLUSIONS: The results highlight the sensitivity of MR wrist examination and its diagnostic benefit in clinically suspected paediatric scaphoid fractures. In addition, it reflects the prudent referral nature of general practitioners.

Costs analysis and comparison of usefulness of acute MRI and 2 weeks of cast immobilization for clinically suspected scaphoid fractures.

BACKGROUND AND PURPOSE: Fractures of the scaphoid are often not detected on initial plain radiographs. Conventional management of clinically suspected scaphoid fractures is cast immobilization for 2 weeks and then reassessment. Early MRI is a diagnostic alternative. We compared the cost and usefulness of the early MRI diagnostic strategy with that of conventional management. PATIENTS AND METHODS: This prospective pseudo-randomized study included patients between 18 and 49 years of age who attended Bergen Accident and Emergency Department, Bergen, Norway during 1 year in 2009-2010, after sustaining an acute wrist trauma in the previous week and with a clinically suspected scaphoid fracture. 61 patients were investigated with acute MRI, while 63 patients received standard treatment as a control group. We used cost-minimization analysis to estimate the cost of the 2 patient groups. RESULTS: Concerning cost, there were no statistically significant differences in the total direct medical costs or in indirect costs between the groups. Concerning usefulness, patients in the MRI group without a fracture (n = 35) used a cast for fewer days (mean 1 day) than patients in the control group with no fractures (n = 52) (mean 14 days; p < 0.001). They had less than half the number of days on sick leave than patients in the control group (mean 7 days vs. 15 days; p = 0.002). INTERPRETATION: In a Norwegian setting, an early MRI was of value in patients with clinically suspected scaphoid fracture and normal plain radiographs.

Intraosseous rotation of the scaphoid: assessment by using a 3D CT model--an anatomic study.

OBJECTIVES: The purpose of this study was to assess intraosseous rotation as the third dimension of scaphoid anatomy on a 3D CT model using common volume rendering software to impact anatomical reconstruction of scaphoid fractures. METHODS: CT images of 13 cadaver wrist pairs were acquired. Reference axes for the alignment of distal and proximal scaphoid poles were defined three-dimensionally. Two methods for rotation measurement-the reference axis method (RAM) and the scapho-trapezio-trapezoidal joint method (STTM)-were developed and compared by three independent observers. RESULTS: Rotation measured by the RAM averaged 66.9° ± 7 for the right and 67.2° ± 5.8 for the left wrists. Using the STTM there was a mean rotation of 68.6° ± 6.6 for the right and 68.6° ± 6.8 for the left wrists. The overall results showed a significant variability of the measured values between different specimens (P < 0.05). There was no significant difference between left and right wrists of the same specimen, neither for the RAM (P = 0.268) nor for the STTM (P = 0.774). Repeatability coefficients between the observers were low, indicating good repeatability. CONCLUSIONS: The presented methods are practical tools to quantify intraosseous rotation between distal and proximal scaphoid poles using common volume rendering software. For clinical application the opposite side provides the best reference values to assess malrotation in scaphoid fracture cases. KEY POINTS: Scaphoid intraosseous rotation can be measured using common volume rendering software. The opposite uninjured side provides good reference values for rotation measurement. Assessment of malrotation may impact anatomical reconstruction of scaphoid fractures.

[Radiometric assessment of wrist angle values, linear parameters of the forearm and wrist ratios]. / Normy wybranych katów nadgarstka, dlugosci przedramienia i wspólczynników nadgarstka.

With the device of our own invention suitable for static X-ray examination of the wrist 12 radiographic parameters were evaluated. 100 radiograms regarded normal were analyzed, obtained as a comparative in unilateral wrist trauma patients group. Age of the patients ranged from 18 to 60 years. No comparative studies in regard to sex were performed. Obtained data were statistically analyzed. Subsequent values of the radiometric parameters were obtained: scaphoid-lunate angle (SL) 48.61 degrees, radio-lunate angle (RL): -0.83 degrees, palmar inclination of the distal radius metaphysis (RI): 25.96. The most significant linear parameters measured: ulnar length 0.18 mm, ulnar transposition (UT): 0.339 mm.