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Open Access Research article

Errors in fracture diagnoses in the emergency department – characteristics of patients and diurnal variation

Peter Hallas* and Trond Ellingsen

BMC Emergency Medicine 2006, 6:4  doi:10.1186/1471-227X-6-4

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4 day delay in fracture diagnosis raises concern

Dustin Paz   (2006-08-03 15:08)  California Department of Health email

I'm interested to know why the 'Correct diagnosis was delayed 3.9 days on average (s.d. 0.5; median 1 day)' I wonder what policy was in place to rectify the discrepancy, and if so what it was. 4 days seems like an extended amount of time to correctly interpret the study.

Competing interests

None declared

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Authors' reply

Peter Hallas   (2006-08-03 15:07)  . email

We thank Dr. Hopkins for the comments. There are indications in our study that many of the fractures simply were difficult to diagnose even for experienced doctors: a resident had been called by the intern to see the x-rays in 24 of the 61 cases of error (p<0.05) thus indicating that the intern on call was aware that interpretation the particular x-rays might be difficult. In addition several mistakes were made even when pictures had been reviewed by a consultant in orthopaedics.

We excluded scaphoid and rib fractures from the study because in some cases these fractures should be diagnosed on the basis of clinical examination alone even in the absence of a positive finding on the x-rays; thus based solely on the x-rays findings it would be misleading to claim that a diagnosis of one these fractures was false-positive.

Our showed that no specific anatomical region were especially at risk for misdiagnosis; however, the overall number of misdiagnosed fractures in our study was too small to address the question of trauma mechanisms and fracture types. We agree with Dr. Hopkins that it would be enlightening to see a study that identify if there are any specific fractures that are especially at risk of being misdiagnosed.

Peter Hallas

Trond Ellingsen

Competing interests

None declared

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Experience and Cause

Dave Hopkins   (2006-05-31 12:45)  N/A

This study is truly comprehensive and I commend you on your efforts. However, I do believe that a lack of EXPERIENCED doctors, as you mentioned once in the manuscript, are really the cause of misdiagnosed fractures. Also, you failed to include rib fractures and scaphoid fractures in your study. I feel that these two types of fractures should be included in your manuscript due to the fact that they are two of the most common types of fractures typically seen in a common Emergency Department. Also, I do believe that the cause of said fracture should be included in your data. Some fractures caused by difficult to diagnose pathologies can be easily overseen. For example, if a leg is broken due to an osteosarcoma, the fracture may be difficult to diagnose along with the condition itself. This study, however, is very competent and could be published in the Journal of the American Medical Association with the proper adjustments.

Competing interests

None declared

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