Satisfaction of Search in Multitrauma Patients: Severity of Detected Fractures

Abstract

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.

Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis

“…Additionally, double reading strategies of CT and X-ray images have been proven to reduce the incidence of missed injuries [1]. Berbaum et al [3] analysed the 'satisfaction of search' effect, i.e. the effect that concomitant injuries are missed after one, often serious, injury has been detected, in diagnostic imaging by systematically adding fractures of different severity to the image collection of multiple trauma patients.…”

Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review

“…Some studies have shown that the severity of the patient's presentation is inversely related to the detection of secondary trauma (5). This is partly due to the 'satisfaction of search', which is the propensity to overlook less obvious conditions after detecting a more apparent injury (13,14). In addition, because a large number of patients with scapular fractures are unconscious at the time of presentation, a brachial plexus examination must wait and, thus, can be forgotten later in a patient's hospital course.…”

Improved implementation of the abnormality manipulation software tools

“…1.1 Perception research with actual medical images is difficult because of the lack of control of the images and because of the lack of truth data [1][2][3][4][5]. We have developed software tools that allow the manipulation of images to remove or introduce abnormalities specifically for perception research [6].…”