Commonly missed injuries in the accident and emergency department

Abstract

Accident and emergency (A&E) medicine is a high-risk speciality in which the majority of patients are managed by junior doctors with limited clinical experience. A review of the literature identi® ed that the rate of missed injury ranges from 0.4 to 65%. Missed injuries are by de® nition preventable and have multiple implications for patients and health-care workers. This article reviews the types of injury that are commonly missed in A&E departments and identi® es the errors that have been made in the past, with recommendations for management strategies to reduce the incidence of missed injury.

The Silence of a Precarious Fracture: Road Traffic Accident in a Chronic Spinal Cord Injury Patient

“…NICE recommends whole body CT (vertex to mid thigh) in adults with major blunt trauma with suspected multiple injuries (10) . Doctors either have ignored patients complains of pain or have been distracted by injuries elsewhere or being unable to elicit pain due to head injury, alcohol or drugs (2) . The majority of the errors are made by junior doctors (even up to 85%).…”

“…ED consultants and even senior radiologists (3.4%) form a small proportion. (2,5) . Fractures can exist without being evident on examination or imaging (6) .…”

“…As timing is crucial a systematic approach as endorsed by various life support course that can be rapidly and accurately applied is essential (6,7). A rapid primary survey, famously recalled as ABCDEs (airway &C-spine, breathing, circulation, disability, exposure &environment) followed by a detailed head to toe secondary survey is the standard of management in trauma (2,4,6). In our patient the complete exposure (E) appears to have been missed which further led to impediment in secondary head to toe survey too.…”

“…However, a proper history, in depth clinical examination and following clear guidelines as dictated by various life support courses help to minimize the missed fractures (4) . The incidence of missed injuries as reported by various studies is variable from 1.3%-39% depending on the methods used by the researchers to retrieve the data (2,3). It is of interest to know that most missed abnormalities on radiographs were not difficult to diagnose (5) .…”

“…Diagnostic errors are part and parcel of all branches of medicine and all physicians have potential to make a mistake. Missed injuries usually lead to less optimal outcome for the patient (2) . Some patients may die due to the missed injury or suffer a lifelong disability.…”