Overlooked extremity fractures in the emergency department.

Background: The purpose of the study was to analyze the accuracy of interpretation of extremity traumas by emergency physicians (EP) to determine the most difficult areas for interpretation in comparison to official radiology reports of direct X-ray.

Methods: Radiologist reports and EP reports of direct X-rays from isolated extremity trauma patients were retrospectively compared from 01.05.2011 to 31.05.2011. A total of 181 fractures in 608 cases were confirmed.

Results: The locations of the misinterpreted fractures were ankle and foot (51.4%), wrist and hand (32.4%), elbow and forearm (5.4%), shoulder and upper arm (5.4%), hip and thigh (2.7%), and knee and leg (2.7%). The diagnostic accuracy of the EPs and radiologists were not significantly different (kappa=0.856, p=0.001).

Conclusion: Knowledge about the types of fractures that are most commonly missed facilitates a specifically directed educational effort.