Missed fractures resulting from satisfaction of search effect

Berbaum, Kevin S.; El‐Khoury, Georges Y.; FrankenJr., Edmund A.; Kuehn, David M.; Meis, David M.; Dorfman, Donald D.; Warnock, Niall G.; Thompson, Brad; Kao, Simon C.; Kathol, Mary H.

doi:10.1007/bf02614935

Cited by 48 publications

(39 citation statements)

References 9 publications

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“…The "SOS effect" can only be verified when this definition holds, and where we measure detection accuracy in a way that is not altered when sensitivity is traded for compensatory changes in specificity. Only one laboratory study demonstrating the SOS effect in this way with radiographic studies of patients suffering from multiple injuries is available (2). Our first experiment replicated the SOS effect in multi-trauma patients with modern digital acquisition and display methods using new images and readers.…”

Section: Discussionmentioning

confidence: 71%

“…Unlike previous studies of SOS (2,3), the imaging modalities presenting the added and test fractures were different. This opens the possibility that CT eliminated SOS because SOS effects do not extend from one imaging modality to another.…”

Section: Discussionmentioning

confidence: 86%

“…Whether the test fracture appeared in the second or third examination was random, but the same order was used for both experimental conditions in all experiments. The 47 test fractures were presented on digital radiographs of the foot [15], ankle [4], tibia/fibula [2], knee [3], shoulder [4], arm [3], elbow [1], wrist [3], and hand/fingers [8]. The 97 normal examinations appearing in the second or third positions of the series (47 with the test fractures, and 54 as pairs to make 27 normal patients) were presented on digital radiographs of the foot [7], ankle [13], tibia/fibula [3], knee [20], pelvis [19], chest [15], shoulder [3], arm [3], elbow [5], wrist [2], and hand/fingers [7].…”

Section: Methodsmentioning

confidence: 99%

“…This display procedure insured that images with added fractures would appear before those with test fractures. In the previous study (2), test and added fractures were randomly distributed in the simulated series and so could appear in either order. Assuming that discovery of the added fracture causes subsequently viewed test fractures to be overlooked; the current procedure of presenting added fractures first affords the chance that each simulated patient may contribute to an observed SOS effect.…”

Section: Simulated Multi-trauma Patientsmentioning

confidence: 99%

“…A "satisfaction of search" (SOS) effect has been demonstrated in which the discovery of a fracture on one image interfered with the detection of a subtle fracture on another image of the same patient (2). Detection of subtle test fractures was substantially reduced when additional fractures were included in other images of each multi-trauma series.…”

Section: Introductionmentioning

confidence: 99%

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Satisfaction of Search in Multitrauma Patients: Severity of Detected Fractures

et al. 2007

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Purpose-Satisfaction of search (SOS) occurs when an abnormality is missed because another abnormality has been detected. This research studied whether the severity of a detected fracture determines whether subsequent fractures are overlooked.Materials and Methods-Each of seventy simulated multi-trauma patients presented examinations of three anatomic areas. Readers evaluated each patient under two experimental conditions: when the images of the first anatomic area included a fracture (the SOS condition), and when it did not (the control condition). The SOS effect was measured on detection accuracy for subtle test fractures presented on examinations of the second and third anatomic areas. In an experiment with twelve radiology readers, the initial SOS radiographs showed non-displaced fractures of extremities, fractures associated with low morbidity. In another experiment with twelve different radiology readers, the initial examination, usually a CT, showed cervical and pelvic fractures of the type associated with high morbidity. Because of their more direct role in patient care, the experiment using high morbidity SOS fractures was repeated with seventeen orthopedic readers.Results-Detection of subtle test fractures was substantially reduced when fractures of low morbidity were added (p<0.01). No similar SOS effect was observed in either experiment in which added fractures were associated with high morbidity. Conclusion-The satisfaction of search effect in skeletal radiology was replicated, essentially doubling the evidence for SOS in musculoskeletal radiology, and providing an essential contrast to the absence of SOS from high morbidity fractures.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 86%