Missed fractures in the emergency department

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.