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Errors in Radiology pp 39–50Cite as

Missed Fractures in the Emergency Department

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Abstract

Diagnostic errors are important in all branches of medicine as they are an indication of inadequate patient care. Medically, the significance of a diagnostic error in an Emergency Department (ED) varies from minimal to potentially life threatening. In other patients a delay in diagnosis may negatively influence the long-term results, increase operative risks, and cause additional pain and suffering. However, all errors have implications for patient care. Moreover, patients are often distressed that an error has been made, which may complicate their relationship with the doctor or the hospital [1]. In the ED, clinically important diagnostic errors are relatively common among polytrauma patients, in whom orthopedic injuries predominate but also constitute 75% of missed diagnoses [2]. Spinal injuries account for approximately 10% of all initially missed diagnoses. These are especially common at the craniocervical junction (40–50% of all initially missed spinal injuries) and at the cervico-thoracic junction.

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References

  1. Guly HR (2001) Diagnostic errors in an accident and emergency department. Emerg Med J 18:263–269

    Article  PubMed  CAS  Google Scholar 

  2. Brooks A, Holroyd B, Riley B (2004) Missed injury in major trauma patients. Injury 35:407–410

    Article  PubMed  Google Scholar 

  3. Hoffman JR, Schriger DL, Mower W et al (200) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 343:94–99

    Google Scholar 

  4. Stiell IG, Wells GA, Vandemheen KL et al (2001) The Canadian C-Spine rule for radiography in alert and stable trauma patients. JAMA 286:1841–1848

    Article  PubMed  CAS  Google Scholar 

  5. Mower WR, Oh JY, Zucker MI et al (2001) Occult and secondary injuries missed by plain radiography of the cervical spine in blunt trauma patients. Emerg Radiol 8:200–206

    Article  Google Scholar 

  6. Woodring JH, Lee C (1993) The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. J Trauma 34:32–39

    Article  PubMed  CAS  Google Scholar 

  7. Davis JW, Phreaner DL, Hoyt DB et al (1993) The etiology of missed cervical spine injuries. J Trauma 34:342–346

    Article  PubMed  CAS  Google Scholar 

  8. Daffner RH, Wippold FJ II, Bennett DL et al (2009) ACR appropriateness criteria suspected spine trauma. http://www.guideline.gov/content.aspx

    Google Scholar 

  9. Cain G, Shepherdson J, Elliott V et al (2010) Imaging suspected cervical spine injury: plain radiography or computed tomography? Systematic review. Radiography 16:68–77

    Article  Google Scholar 

  10. Moscati RM, Lerner EB, Pugh JL (2007) Application of clinical criteria for ordering radiographs to detect cervical spine fractures. Am J Emerg Med 25:326–330

    Article  PubMed  Google Scholar 

  11. Reid DC, Henderson R, Saboe L et al (1987) Etiology and clinical course of missed spine fractures. J Trauma 27:980–986

    Article  PubMed  CAS  Google Scholar 

  12. Rhee PM, Bridgman A, Acosta JA et al (2002) Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films. J Trauma 53:663–667

    Article  PubMed  Google Scholar 

  13. Dennis LN, Rogers LF (1989) Superiormediastinal widening from spine fractures mimicking aortic rupture on chest radiographs. AJR 152:27–30

    PubMed  CAS  Google Scholar 

  14. Bernstein M (2010) Easily missed thoracolumbar spine fracture. Eur J Radiol 74:6–15

    Article  PubMed  Google Scholar 

  15. Beaunoyer M, St-Vil D, Lallier M et al (2001) Abdominal injuries associated with thoracolumbar fractures after motor vehicle collision. J Pediatr Surg 36:760–762

    Article  PubMed  CAS  Google Scholar 

  16. Krueger MA, Green DA, Hoyt D et al (1996) Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop 327:191–195

    Article  PubMed  Google Scholar 

  17. Samilson RL, Prieto V (1983) Posterior dislocation of the shoulder in athletes. Clin Sports Med 2:369–378

    PubMed  CAS  Google Scholar 

  18. Hawkins RJ, Neer CS, Pianta RM et al (1987) Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 69:9–18

    PubMed  CAS  Google Scholar 

  19. Neviaser TJ (1980) Old unreduced dislocations of the shoulder. Orthop Clin North Am 11:287–294

    PubMed  CAS  Google Scholar 

  20. Schultz TJ, Jacobs B, Patterson RL (1969) Unrecognized dislocations of the shoulder. J Trauma 9:1009–1023

    Article  Google Scholar 

  21. Herzberg G, Comtet JJ, Linscheid RL et al (1993) Perilunate dislocations and fracture dislocations: a multicenter study. J Hand Surg Am 18:768–779

    Article  PubMed  CAS  Google Scholar 

  22. Perron AD, Brady WJ, Keats TE et al (2001) Orthopedic pitfalls in the ED: lunate and perilunate injuries. Am J Emerg Med 19:157–162

    Article  PubMed  CAS  Google Scholar 

  23. Ring D, Jupiter JB, Herndon JH (2000) Acute fractures of the scaphoid. J Am Acad Orthop Surg 8:225–231

    PubMed  CAS  Google Scholar 

  24. Ritchie JV, Munter DW (1999) Emergency department evaluation and treatment of wrist injuries. Emerg Med Clin North Am 17:823–842

    Article  PubMed  CAS  Google Scholar 

  25. Larsen CF, Brodum V, Skov O (1992) Epidemiology of scaphoid fractures in Odense, Denmark. Acta Orthop Scand 63:216–220

    Article  PubMed  CAS  Google Scholar 

  26. Mehta M, Brautigan MW (1990) Fracture of carpal navicular. Efficacy of clinical findings and improved diagnosis of six view radiography. Ann Emerg Med 19:225–231

    Article  Google Scholar 

  27. Waizengger M, Barton NJ, David TR et al (1994) Clinical signs in scaphoid fractures. J Hand Surg Br 19:743–746

    Article  Google Scholar 

  28. Leslie IJ, Dickson RA (1981) The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg Br 63:225–230

    PubMed  Google Scholar 

  29. Dias JJ, Brenkel IJ, Finlay DB (1989) Patterns of non union in fractures in the waist of scaphoid. J Bone Joint Surg Br 71:307–310

    PubMed  CAS  Google Scholar 

  30. Lindstrom G, Nystrom A (1993) Natural history of scaphoid non-union, with special reference to ‘asymptomatic ‘cases. J Hand Surg Br 18:403–406

    Google Scholar 

  31. Tiel-van Buul MM, van Beek EJ, Borm JJ et al (1993) The value of radiographs and bone scintigraphy in suspected scaphoid fracture. A statistical analysis. J Hand Surg Br 18:403–406

    PubMed  CAS  Google Scholar 

  32. Nguyen Q, Chaudhry S, Sloan E et al (2008) The clinical scaphoid fracture: early computed tomography as a practical approach. Ann R Coll Surg Engl 90:488–491

    Article  PubMed  CAS  Google Scholar 

  33. Amis AA, Miller JH (1995) The mechanisms of elbow fractures: an investigation using impact tests in vitro. Injury 26:163–168

    Article  PubMed  CAS  Google Scholar 

  34. Celli A, Nicoli E (2004) Fractures of the radial head associated with dislocation of the elbow. Chir Organi Mov 89:7–19

    PubMed  CAS  Google Scholar 

  35. Greenspan A, Norman A, Rosen H (1984) Radial head-capitellum view in elbow trauma: clinical application and radiographic-anatomic correlation. AJR Am J Roentgenol 143:355–359

    PubMed  CAS  Google Scholar 

  36. Benger JR, Lyburn ID (2003) What is the effect of reporting all emergency department radiographs? Emerg Med J 20:40–43

    Article  PubMed  CAS  Google Scholar 

  37. Judd DB, Kim DH (2002) Foot fractures frequently misdiagnosed as ankle sprains. Am Fam Physician 66:785–794

    PubMed  Google Scholar 

  38. Lowery RB, Claxon JH (1996) Fractures of the calcaneus: Part 1: anatomy, injury, mechanism, and classification. Foot Ankle Nit 17:230–235

    CAS  Google Scholar 

  39. Barei DP, Bellabarba C, Sangeorzan et al (2002) Fractures of the calcaneus. Orthop Clin North Am 33:263–285

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Emergency Radiology, “San Camillo” Hospital, Rome, Italy

    Vittorio Miele, Michele Galluzzo & Margherita Trinci

Authors
  1. Vittorio Miele
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  2. Michele Galluzzo
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  3. Margherita Trinci
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Editor information

Editors and Affiliations

  1. Department of Diagnostic Radiological Imaging, “A. Cardarelli” Hospital, Naples, Italy

    Luigia Romano  & Antonio Pinto  & 

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© 2012 Springer-Verlag Italia

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Miele, V., Galluzzo, M., Trinci, M. (2012). Missed Fractures in the Emergency Department. In: Romano, L., Pinto, A. (eds) Errors in Radiology. Springer, Milano. https://doi.org/10.1007/978-88-470-2339-0_5

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  • DOI: https://doi.org/10.1007/978-88-470-2339-0_5

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2338-3

  • Online ISBN: 978-88-470-2339-0

  • eBook Packages: MedicineMedicine (R0)

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