Radiologic discrepancies in diagnosis of fractures in a Dutch teaching emergency department: a retrospective analysis

Springer Science and Business Media LLC - Tập 28 - Trang 1-7 - 2020
Laura Mattijssen-Horstink1, Judith Joëlle Langeraar2, Gert Jan Mauritz2, William van der Stappen3, Maarten Baggelaar1, Edward Camillus Thwan Han Tan3,1
1Department of Emergency Medicine, Nijmegen, The Netherlands
2Department of Emergency Medicine, Rijnstate, Arnhem, The Netherlands
3Department of Surgery, Nijmegen, the Netherlands

Tóm tắt

Missed fractures in the emergency department (ED) are common and may lead to patient morbidity. To 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. A 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. A 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. Adequate 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.

Tài liệu tham khảo

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