Abstract
BackgroundMissed fractures in the emergency department (ED) are common and may lead to patient morbidity.AimTo determine the rate and nature of radiographic discrepancies between ED treating physicians, radiologists and trauma/orthopaedic surgeons and the clinical consequences of delayed diagnosis. A secondary outcome measurement is the timeframe in which most fractures were missed.MethodsA single-centre retrospective analysis of all missed fractures in a general teaching hospital from 2012 to 2017 was performed. Data regarding missed fractures were provided by the hospital’s complication list and related database. Additional data were retrieved from the electronic medical records as required for the study.ResultsA total of 25,957 fractures were treated at our ED. Initially, 289 fractures were missed by ED treating physicians (1.1%). The most frequently missed fractures were the elbow (28.6%) and wrist (20.8%) in children, the foot (17.2%) in adults and the pelvis and hip (37.3%) in elderly patients. Patients required surgery in 9.3% of missed fractures, received immobilization by a cast or brace in 45.7%, had no treatment alterations during the first week in 38.1%. Follow-up data were lacking for 6.9% of cases. 49% of all missed fractures took place between 4 PM and 9 PM. There is a discrepancy in percentages of correctly diagnosed fractures and missed fractures between 5 PM and 3 AM.ConclusionAdequate training of ED treating physicians in radiographic interpretation is essential in order to increase diagnostic accuracy. A daily multidisciplinary radiology meeting is very effective in detecting missed fractures.
Highlights
Failure to diagnose a fracture accounts for up to 80% of emergence department (ED) diagnostic errors and is a leading cause of litigation [1, 2]
Adequate training of emergency department (ED) treating physicians in radiographic interpretation is essential in order to increase diagnostic accuracy
A daily multidisciplinary radiology meeting is very effective in detecting missed fractures
Summary
Failure to diagnose a fracture accounts for up to 80% of emergence department (ED) diagnostic errors and is a leading cause of litigation [1, 2]. Radiography remains the initial modality used to detect a fracture. Radiographs are initially interpreted by ED treating physicians, and clinical practice is dependent on Mattijssen-Horstink et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2020) 28:38. This study aims to determine the rate of error for ED treating physicians, radiologists and trauma/orthopaedic surgeons in the interpretation of performed radiographs for possible fractures. We want to identify the most common diagnostic errors and investigate the clinical consequence of delayed diagnosis. Missed fractures in the emergency department (ED) are common and may lead to patient morbidity
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
