Objectives-To describe the diagnostic errors occurring in a busy district general hospital accident and emergency (A&E) department over four years. Method-All diagnostic errors discovered by or notified to one A&E consultant were noted on a computerised database. Results-953 diagnostic errors were noted in 934 patients. Altogether 79.7% were missed fractures. The most common reasons for error were misreading radiographs (77.8%) and failure to perform radiography (13.4%). The majority of errors were made by SHOs. Twenty two diagnostic errors resulted in complaints and legal actions and three patients who had a diagnostic error made, later died. Conclusions-Good clinical skills are essential. Most abnormalities missed on radiograph were not diYcult to diagnose. Junior doctors in A&E should receive specific training and be tested on their ability to interpret radiographs correctly before being allowed to work unsupervised.

Prognostic/epidemiologic study, level III.