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E2239. Missed Fractures in ER: Learning From the Errors - a Case-Based Review
Authors
  1. Sameer Raniga; Sultan Qaboos University Hospital
  2. Alok Mittal; Sultan Qaboos University Hospital
  3. Aymen Al Hadidi; Sultan Qaboos University Hospital
  4. Hema Choudur; McMaster University
Background
The retrospective error rate in radiology reporting is estimated to be approximately 30%. Errors in interpretation of trauma radiographs include- undercall (miss), overcall, and mimics-misinterpretations. Errors result in compromised patient care with additional unnecessary cross-sectional imaging and unwarranted treatment. Professionally, consequences of erroneous interpretation include but are not limited to the public shame and humiliation, reduced self-confidence, and potential medicolegal hassles.

Educational Goals / Teaching Points
• To understand the theory of error • To analyze the factors that lead to misinterpretation • To illustrate common diagnostic errors in interpretation of trauma radiographs • To propose solutions to reduce errors- a case-based review

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1) Types of error: Perceptual (failure to detect- miss) versus cognitive (interpretative- failure to give appropriate significance to the detected abnormality). 2) Commonly missed fractures- around the shoulder, elbow, wrist, hand, pelvis, knee, ankle, and foot are enumerated. 3) An adequate number of views (radiographic series) for each bone-joint of the extremity is described. 4) Radiographic critique of positioning and its importance in reducing the error is emphasized. 5) Importance of checklist and systematic interpretation of trauma radiographs with appropriate examples. 6) Knowledge of common variants which mimics fracture and how to avoid misinterpretation 7) Importance of additional views or further imaging when initial views are normal or equivocal.

Conclusion
Errors- misses, overcalls, and misinterpretations are equally important. Common radiographic errors and where to look for them can help radiology residents and practicing radiologists. Checklist approach, systematic interpretation, and structured templates are indispensable in reducing errors. Distraction during the working hours needs to be seriously addressed. Departmental quality assurance programs like M and M meetings, discrepancy meetings, Peer review, and audits are mandatory.