[Spinal infection with spinal cord/cauda equina affection requires emergency handling].

Seventeen cases of infections in spinal structures were reported 2010-2017 to the Swedish Health and Social Care Inspectorate (IVO), a government agency responsible for supervising health care, for missed or delayed diagnosis. All patient records were scrutinized in order to find underlying causes and common factors. The delayed diagnoses were equally found among men and women and most frequent in in the age-group 65 to 79 years of age.

[Lumbar spine radiography – unreliable diagnostic accuracy and negligible value for the patients].

Lumbar spine radiography - unreliable diagnostic accuracy and negligible value for the patients In 2016 140 000 lumbar spine radiographies were performed in Sweden (14 000 per million inhabitants) to a cost of about 85 million SEK (≈8.5 million Euro) and a negligible value for the patients with low back pain. In the work-up of low back pain, when imaging is indicated, lumbar spine radiography should be replaced by limited magnetic resonance imaging including a whole lower body coronal STIR sequence or computed tomography with radiation dose adapted to indication and patient age.

[Missed diagnosis of Achilles tendon ruptures most common in elderly patients].

We audited forty-six patients with a rupture of the Achilles tendon notified to the Swedish regulatory authority (the Health and Social Care Inspectorate) due to suspicion of malpractice. The patients' history and clinical presentation differed from those with a more classical acute rupture. The diagnostic errors were often found in patients older than 60 years, they were just as common in women as in men and the symptoms often had a subacute start.

[Failing primary clinical investigation is common in missed hip fractures].

Failing primary clinical investigation is common in missed hip fractures Diagnostic errors in 43 patients with hip fracture handled by the Swedish Health and Social Care Inspectorate were analyzed. Diagnostic errors were most likely a consequence of insufficient initial history, examination and/or radiologic examination. The most common isolated cause was delayed examination by a physician outside of a hospital setting.

[Diagnostic imaging no answer in the diagnosis of appendicitis].

Diagnostic errors in 49 patients with appendicitis handled by the Swedish Health and Social Care Inspectorate were analyzed. Diagnostic errors were more common in young or old patients, and among patients with atypical symptoms. Adjunct diagnostic tools, such as computerized tomography and/or ultrasound examination, also have limitations as regards diagnostic precision, and should therefore not be seen as golden standard.