{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:49:54Z","timestamp":1782488994839,"version":"3.54.5"},"reference-count":25,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T00:00:00Z","timestamp":1601337600000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["843002802"],"award-info":[{"award-number":["843002802"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CZ","award":["201700008"],"award-info":[{"award-number":["201700008"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,8,22]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Some scaphoid fractures become visible on radiographs weeks after a trauma which makes normal radiographs directly after trauma unreliable. Untreated scaphoid fractures can lead to scaphoid non-union progressing to osteoarthritis. Therefore, the general treatment for patients with a clinically suspected scaphoid fracture and normal initial radiographs is immobilisation with below-elbow cast for 2 weeks. However, most of these patients are treated unnecessarily because eventually less than 10% of them are diagnosed with an occult scaphoid fracture. To reduce overtreatment and costs as a result of unnecessary cast treatment in patients with a clinically suspected scaphoid fracture and normal initial radiographs, we designed a study to compare below-elbow cast treatment with supportive bandage treatment. We hypothesise that the functional outcome after 3 months is not inferior in patients treated with supportive bandage compared to patients treated with below-elbow cast, but with lower costs in the supportive bandage group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The SUSPECT study is an open-labelled multicentre randomised controlled trial with non-inferiority design. A total of 180 adult patients with a clinically suspected scaphoid fracture and normal initial radiographs are randomised between two groups: 3 days of supportive bandage or 2 weeks of below-elbow cast. We aim to evaluate the functional outcome and cost-effectiveness of both treatments. The primary outcome is the functional outcome after 3 months, assessed with the Quick Disability of the Arm, Shoulder and Hand score. Secondary outcomes include functional outcome, recovery of function, pain, patient satisfaction, quality of life and cost-effectiveness measured by medical consumption, absence from work or decreased productivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The Medical Ethics Committee of the Erasmus MC Medical Centre, Rotterdam, approved the study protocol (MEC-2017-504). We plan to present the results after completion of the study at (inter)national conferences and publish in general peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>NL6976.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-036998","type":"journal-article","created":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T17:41:03Z","timestamp":1601401263000},"page":"e036998","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Clinically SUspected ScaPhoid fracturE: treatment with supportive bandage or CasT? \u2018Study protocol of a multicenter randomized controlled trial\u2019 (SUSPECT study)"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9412-1134","authenticated-orcid":false,"given":"Abigael","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Reijman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald A","family":"Kraan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Reinier de Graaf Hospital, Delft, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina M C","family":"Mathijssen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Reinier de Graaf Hospital, Delft, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A","family":"Koopmanschap","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan A N","family":"Verhaar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Mol","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost W","family":"Colaris","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,29]]},"reference":[{"key":"2026062608032872000_10.9.e036998.1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00453208"},{"key":"2026062608032872000_10.9.e036998.2","article-title":"Variations in management of suspected scaphoid fractures] Variatie in beleid bij vermoeden op scafoidfractuur","volume":"156","author":"Mallee","year":"2012","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2026062608032872000_10.9.e036998.3","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ejrad.2017.10.010","article-title":"Diagnostic value of cone beam computed tomography (CBCT) in occult scaphoid and wrist fractures","volume":"97","author":"Borel","year":"2017","journal-title":"Eur J Radiol"},{"key":"2026062608032872000_10.9.e036998.4","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3109\/17453674.2014.986627","article-title":"Costs analysis and comparison of usefulness of acute MRI and 2 weeks of cast immobilization for clinically suspected scaphoid fractures","volume":"86","author":"Bergh","year":"2015","journal-title":"Acta Orthop"},{"key":"2026062608032872000_10.9.e036998.5","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s00068-015-0594-9","article-title":"Comparison of MRI, CT and bone scintigraphy for suspected scaphoid fractures","volume":"42","author":"de Zwart","year":"2016","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026062608032872000_10.9.e036998.6","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.annemergmed.2014.10.029","article-title":"What physical examination findings and diagnostic imaging modalities are most useful in the diagnosis of scaphoid fractures?","volume":"65","author":"Gemme","year":"2015","journal-title":"Ann Emerg Med"},{"key":"2026062608032872000_10.9.e036998.7","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(88)90003-4"},{"key":"2026062608032872000_10.9.e036998.8","doi-asserted-by":"publisher","DOI":"10.1016\/0266-7681(88)90057-5"},{"key":"2026062608032872000_10.9.e036998.9","doi-asserted-by":"publisher","DOI":"10.1016\/0266-7681(88)90058-7"},{"key":"2026062608032872000_10.9.e036998.10","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1302\/0301-620X.63B2.7217146","article-title":"The fractured carpal scaphoid. natural history and factors influencing outcome","volume":"63-B","author":"Leslie","year":"1981","journal-title":"J Bone Joint Surg Br"},{"key":"2026062608032872000_10.9.e036998.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"},{"key":"2026062608032872000_10.9.e036998.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586"},{"key":"2026062608032872000_10.9.e036998.13","unstructured":"Ciwit BV . Castor electronic data capture. Amsterdam, 2016."},{"key":"2026062608032872000_10.9.e036998.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2014.06.004"},{"key":"2026062608032872000_10.9.e036998.15","first-page":"S28","article-title":"Reliability and validity of the delta finger-to-palm (FTP), a new measure of finger range of motion in systemic sclerosis","volume":"28","author":"Torok","year":"2010","journal-title":"Clin Exp Rheumatol"},{"key":"2026062608032872000_10.9.e036998.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0753-9053(86)80053-9"},{"key":"2026062608032872000_10.9.e036998.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-1130(96)80068-8"},{"key":"2026062608032872000_10.9.e036998.18","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200201000-00006"},{"key":"2026062608032872000_10.9.e036998.19","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/j.apmr.2016.11.023","article-title":"Validation of the QuickDASH and DASH in patients with distal radius fractures through agreement analysis","volume":"98","author":"Tsang","year":"2017","journal-title":"Arch Phys Med Rehabil"},{"key":"2026062608032872000_10.9.e036998.20","doi-asserted-by":"publisher","DOI":"10.1302\/2046-3758.71.BJR-2017-0081.R1"},{"key":"2026062608032872000_10.9.e036998.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2012.11.028"},{"key":"2026062608032872000_10.9.e036998.22","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s10926-014-9547-0","article-title":"Validation of the EQ-5D in patients with traumatic limb injury","volume":"25","author":"Hung","year":"2015","journal-title":"J Occup Rehabil"},{"key":"2026062608032872000_10.9.e036998.23","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.jval.2015.05.009","article-title":"The iMTA productivity cost questionnaire: a standardized instrument for measuring and Valuing health-related productivity losses","volume":"18","author":"Bouwmans","year":"2015","journal-title":"Value Health"},{"key":"2026062608032872000_10.9.e036998.24","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2014.4893"},{"key":"2026062608032872000_10.9.e036998.25","doi-asserted-by":"publisher","DOI":"10.1177\/1753193413498547"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-036998","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:12:53Z","timestamp":1782486773000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-036998"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":25,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9,29]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/bmjopen-2020-036998"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-036998","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}