Trial reportThe Journal of hand surgery, European volume2026
Investigating the diagnostic accuracy of physical examination in digital nerve injury: a study within a trial.
Trial report in The Journal of hand surgery, European volume, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionDigital nerve injuries are the most common peripheral nerve injuries, usually diagnosed through physical examination and confirmed by surgical exploration. Exploration, while important for informing management, carries risk and associated healthcare costs. The diagnostic accuracy of physical examination in identifying complete nerve lacerations requiring repair remains uncertain. This study within a trial (SWAT) aimed to determine the positive predictive value (PPV) of specialist physical examination in identifying complete digital nerve lacerations requiring repair.
methodsThis prospective SWAT was embedded within the NEON (Digital Nerve, Suture or Not) randomized controlled trial (ISRCTN16211574). Adult patients presenting with suspected complete digital nerve injury in flexor zone 2 across nine UK NHS hospitals (September 2020 to March 2024) were included. Physical examination was performed by hand surgery specialists, with surgical exploration as the reference standard. The primary outcome was the positive predictive value (PPV) of physical examination for complete laceration requiring repair.
resultsOf 593 referred patients, 242 underwent surgical exploration. Complete laceration was confirmed in 137 (true positives), while 105 had partial or no visible lacerations (false positives), yielding a PPV of 57%. DISCUSSION: Specialist physical examination was unable to reliably predict complete digital nerve injury, resulting in a high false positive rate, with 43% of explored patients not requiring repair. Despite this limitation, surgical exploration remains pivotal, as no alternative bedside test currently provides sufficient accuracy. These findings highlight the urgent need for improved point-of-care diagnostic modalities to support surgical decision making and informed patient consent. LEVEL OF EVIDENCE: II.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.