Trial reportThe bone & joint journal2019
Clinical and cost implications of using immediate MRI in the management of patients with a suspected scaphoid fracture and negative radiographs results from the SMaRT trial.
Trial report in The bone & joint journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Artificial intelligence software to help detect fractures on X-rays in urgent care: An Early Value Assessment.Health technology assessment (Winchester, England) · 2026Pooled it
- Interdisciplinary consensus statements on imaging of scaphoid fractures.European radiology · 2026Article
- Single-sequence low-field 3D T1-weighted MRI for scaphoid fracture detection compared to radiography: prospective diagnostic accuracy pilot study.Emergency radiology · 2026Article
- Editorial: Pediatric scaphoid fractures-a problem we need to take more seriously?Skeletal radiology · 2026Article
- Article
- Qualitative study exploring stakeholder perspectives on the use of early MRI in wrist injury pathways in the UK NHS.BMJ open · 2025Article
- Treatment Options, Return to Play, and Functional Performance after Operatively and Non-operatively Managed Acute Scaphoid Fractures.Current reviews in musculoskeletal medicine · 2025Review
- Scaphoid Fractures and Nonunion: A Survey-based Review of Hand Surgeon's Practice and the Evidence.Journal of hand surgery global online · 2024Article
- An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures.Journal of clinical medicine · 2024Review
- The reliability and clinical utility of a simple MRI based classification tool for acute scaphoid injuries: the OxSMART.Bone & joint open · 2022Article
- A Virtual Fracture Clinic Pathway for Managing Suspected Paediatric Scaphoid Fractures.Cureus · 2022Article
- The management of suspected scaphoid fractures in the UK: a national cross-sectional study.Bone & joint open · 2021Article
- Suspected scaphoid injuries managed by MRI direct from the emergency department : a single-centre prospective cohort study.Bone & joint open · 2021Article
- Thousand shades of gray - The role of imaging display in diagnosis of occult scaphoid fractures - A pilot study.Journal of orthopaedicsArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
aimsThe aim of the Scaphoid Magnetic Resonance Imaging in Trauma (SMaRT) trial was to evaluate the clinical and cost implications of using immediate MRI in the acute management of patients with a suspected fracture of the scaphoid with negative radiographs. PATIENTS AND
methodsPatients who presented to the emergency department (ED) with a suspected fracture of the scaphoid and negative radiographs were randomized to a control group, who did not undergo further imaging in the ED, or an intervention group, who had an MRI of the wrist as an additional test during the initial ED attendance. Most participants were male (52% control, 61% intervention), with a mean age of 36.2 years (18 to 73) in the control group and 38.2 years (20 to 71) in the intervention group. The primary outcome was total cost impact at three months post-recruitment. Secondary outcomes included total costs at six months, the assessment of clinical findings, diagnostic accuracy, and the participants' self-reported level of satisfaction. Differences in cost were estimated using generalized linear models with gamma errors.
resultsThe mean cost up to three months post-recruitment per participant was £542.40 (sd £855.20, n = 65) for the control group and £368.40 (sd £338.60, n = 67) for the intervention group, leading to an estimated cost difference of £174 (95% confidence interval (CI) -£30 to £378; p = 0.094). The cost difference per participant increased to £266 (95% CI £3.30 to £528; p = 0.047) at six months. Overall, 6.2% of participants (4/65, control group) and 10.4% of participants (7/67, intervention group) had sustained a fracture of the scaphoid (p = 0.37). In addition, 7.7% of participants (5/65, control group) and 22.4% of participants (15/67, intervention group) had other fractures diagnosed (p = 0.019). The use of MRI was associated with higher diagnostic accuracy both in the diagnosis of a fracture of the scaphoid (100.0%
conclusionThe use of immediate MRI in the management of participants with a suspected fracture of the scaphoid and negative radiographs led to cost savings while improving the pathway's diagnostic accuracy and patient satisfaction. Cite this article:
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