Reducing Diagnostic Errors in Musculoskeletal Trauma by Reviewing Non-Admission Orthopaedic Referrals in the Next-Day Trauma Meeting (original) (raw)
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Missed orthopaedic injuries in trauma patients at a rural tertiary trauma centre
innovative publication, 2017
Missed injuries is defined as an injury found after the initial complete patient assessment and diagnostic studies that was directly related to the traumatic event and was identified after first 24 hours following admission. Even though not frequently life-threatening, they may result in significant long-term disability. The aim of this study was to define the incidence of missed orthopaedic injury for adult major trauma patients and to examine the details of missed injuries in order to identify and make comment on potential risk factors for missed injury. 671 admissions in orthopaedics indoor patients in a rural tertiary care centre for the period of 10 months from 1st January 2016 to 31st October 2016 were included for study. 18 patients were identified with delayed diagnoses of the injury. Patients with a decreased level of consciousness or head injury, with intubation/sedation or with alcohol or drug intoxication are unable to give a good history, cooperate with physical exam or identify sources of pain are the main risk factors for missed injuries. Other factors for missing an injury include Inadequate Clinical Assessment, Misinterpretation of Studies and Late Presentation of Observable Findings. Repeated assessments, both clinical and radiological, are mandatory to diminish this problem. In initial evaluation, one still has to treat the greatest threat to life before complete diagnosis of all injuries, but alertness to evolving injuries must remain in mind throughout the patient's hospital stay.
Profile of patients reporting with fractures in the orthopaedics department
National Journal of Clinical Orthopaedics, 2021
Background: Fractures occur in individuals of all ages. The present study was conducted to record fracture reported in orthopaedics department. Materials and Methods: 148 patients with fractures reported in orthopaedics department underwent physical examination along with radiological investigation such as X-ray skull, upper limb, lower limb, CTR scan etc. was performed in each case. Etiology of fracture and associated injuries was also reported. Management of the patient was performed accordingly. Results: Out of 148 patients, males were 80 and females were 68. The most common cause of fracture among patients was road traffic accident seen in 102, fall in 40 and domestic violence in 6 cases. The difference was significant (P< 0.05). Fracture of upper limb was seen in 60, fracture of lower limb in 30, fracture of spine and trunk in 25, fracture of skull, intracranial injury in 33. Associated injuries was contusion in 12, open wound of upper limb in 24, open wound of lower limb in 54 and superficial injury in 28 patients. The difference was significant (P< 0.05). Conclusion: Common type of fractures among patients visiting orthopaedics department was fracture of upper limb, fracture of lower limb, fracture of spine and trunk.
Emergency Medicine Orthopedic Assessment
Emergency Medicine Clinics of North America, 2020
Acute orthopedic injuries are a large component of emergency medicine comprising 10% to 20% of emergency department (ED) visits. Emergency physicians (EPs) treat a wide variety of acute orthopedic conditions from life-and limb-threatening trauma to relatively minor injuries. Despite the relatively high volume of orthopedic injuries seen, studies have shown that EPs have decreased confidence in their musculoskeletal (MSK) skills. EPs perform relatively poorly on standardized tests of MSK knowledge. 1 Medical school curricula contain relatively minuscule amounts of dedicated MSK education. MSK injuries remain the most common cause of litigation and misdiagnosis for EPs. 2-5 Given that orthopedic injuries are commonly seen, and commonly missed, it seems that there is a void that needs to be filled. There is a need to improve our ED orthopedic diagnostic and management skills.
Turkish Journal of Trauma and Emergency Surgery, 2013
Computerized tomography (CT) is a very useful diagnostic method in orthopedic emergency cases where fractures are suspected but cannot be detected through direct radiography, or when the fracture is detected in direct radiography but better evaluation of the anatomical structure is necessary. In this study, we analyzed occurrences of missed fractures in radiographs that were subsequently diagnosed in CT scans. METHODS This was a retrospective study. We examined the medical records of all orthopedic trauma patients who visited our hospital's emergency room due to orthopedic trauma between January 2010 and January 2011 and whose spine, pelvis and extremity CTs were taken. RESULTS Occult fractures were detected using CT in 12 (6.6%) of the children and 102 (6.8%) of the adults. We detected cervical vertebra fractures in 23 patients, femoral neck fractures in 6 patients, and tibia plato fractures in 5 patients, which can cause complications unless immediately acted upon in the emergency room. CONCLUSION CT revealed most missed diagnoses and proved that direct radiography is less capable of detecting fractures of some critical regions. Where there is clinical suspicion, we recommend that before conservative treatment of patients, especially in cases of possible cervical spine and pelvic region fractures, CT should be requested, even if the radiography is normal.
X Ray in Minor Orthopedic Injuries: Is A Must or There Is Something Else to Trust
2020
Background and objectives. The management of minor orthopedic injuries is a routine work at accident & emergency departments, and although many patients undergo radiography. This study aimed to find the best screening test for a fracture in all minor orthopedic injuries with different anatomical sites. Methods. The study is a cross-sectional study. The sample was collected randomly from causality room of accident and emergency department from April to September 2006 in Abo Saleem trauma hospital; Sample size was 1000 minor orthopedic injuries with variable sex and limited age from 5-55-year ages. The data was plotted in two software programs SSPS version 10 and MEDCALC version 11.3.3.0. Results. Our study found that bone tenderness alone is the most superior screening test for requesting radiographs with any patient had the minor orthopedic injury at knee, ankle, hand, forearm, and foot. Moreover, restriction of movement alone is the most superior screening test for requesting radio...
Retrospective analysis of patients who admitted to the emergency service with orthopedic injuries
Journal of Experimental and Clinical Medicine, 2014
Trauma is the main cause of deaths between the ages of 1-44 (Regel et al., 1995; Kandis et al., 2009). The most common causes of trauma are traffic accidents, falls, assault, firearms or penetrating injuries, child and the elderly abuses. Deaths due to trauma rank third among all age groups deaths (Jones, 1980; Kandis et al., 2009). Isolated extremity trauma is rarely causes death and disability with adequate and timely intervention. Orthopedic trauma injuries may be isolated or in conjunction with other system injuries as well (Bayram, 2013). Orthopedic injury-related deaths are often seen with uncontrolled external bleeding. Sometimes large bone fractures may cause silent internal bleeding and this may be life threatening. Extremity traumas may be seen blunt and/or penetrating traumas. In the hospital and pre-hospital early diagnosis and treatment is very important for orthopedics trauma as important as all traumas.
Scholars Journal of Applied Medical Sciences
Background: Orthopedic fractures, traumatic injuries, dislocations, and visceral injuries pose significant mortality and morbidity around the world and are a critical and growing concern for healthcare systems. The aim of this study to assess the pattern of orthopedic fractures and visceral injuries and find factors associated with these fractures. Methods: This study was a retrospective observational study that was conducted on all of the patients who were admitted to the department of orthopedics at Medical College women and Hospital during the study period between April 2018 to June 2022 those who fulfilled the selection criteria were enrolled in this study. A total of 147 Patients of all age groups of either gender with one or more fractures were included. Result: A total of 147 road traffic crash victims with orthopedic fractures ranged from 5 to 85 years old. The majority of respondents, 81 (55.10%), were in the young age group (21 to 40 years) and 26% were female, and 74% wer...
Epidemiology of Trauma Patients Presenting to Orthopaedic Department in A Tertiary Care Hospital
2016
Objective: To record the epidemiological statistics of orthopaedic trauma patients presenting to a major trauma center of Pakistan. Methods: In this descriptive study, 5527 patients who presented to the emergency of Orthopaedics department of Benazir Bhutto Hospital, Rawalpindi from January 2015 to January 2016 were included. Those who presented with serious injuries associated with trauma fulfilled the criteria. Results: Out of 5527 patients, 3002(54.31%) were males and 2525(45.68%) were females with male to female ratio of 1.19:1. Lower limb fractures were found in 2516(45.52%) patients as compared to upper limb fractures, which only occurred in 1625(29.40%) of the patients. Most of the patients who presented with fractures belonged to the age group of 21-30 years. Motorcycle accident victims made up 34.20% of the total 5527 patients under study, making it the leading cause of trauma admissions. A rise was seen in patients presenting due to trauma during summer season (April-Septe...
Frequency and Type of Fractures Entering the Emergency Units of Orthopedic Hospitals
Pakistan Journal of Rehabilitation, 2013
BACKGROUND Trauma is globally encountered in the emergency department on regular intervals placing a burden on the economy through an increase in the mortality and morbidity. Multiple types of fractures have been notified leading from moderate to severe disability. The aim of the study is to assess different types of fracture entering the emergency department, the risk of these fractures and also to find the association between genders. A cross sectional survey was conducted on 450 participants in different Emergency Departments of tertiary care units of Karachi. It has been observed that fracture cases are increasing in emergencies in Karachi. Road Traffic Injuries (RTA) with 41.6% is the most dominant cause of fracture whereas fall or slip injuries and brawl/fight show 22.2% and 14.7% respectively. Generally, alcohol and cigarette smoking has adverse effect yet 91.6% population revealed no relationship. Regional distribution of fracture shows lower limb fracture with 40.9% as most...