Fracture or sprain? junior doctors can’t tell you
Junior doctors in emergency departments are commonly diagnosing wrist fractures as simple sprains, according to a new UK study.
Research carried out at Derriford Hospital in Plymouth shows that such mistakes are being made mostly because trainee doctors are misreading the X-rays.
Lead researcher Dr Henry Guly noted that there was no evidence of patients being harmed as a result of such errors. Nevertheless, he commented, '. . . errors have the potential for causing harm, loss of patient confidence, complaints and legal action. They are also inefficient for the hospital, as patients need to be recalled.'
Analysis showed that 91 per cent of these errors involved abnormalities that were missed on X-ray examination. In a few cases, this was because of poor-quality images, but most were due to the doctors’ failure to correctly interpret what they saw.
Of the total number of all diagnostic errors recorded in this study, 57 (just over 6 per cent) involved patients being wrongly informed that they had a sprained wrist.
Of these, 23 were ‘greenstick’ injuries to the forearm (partial fracture of the bone, as seen when trying to snap a young branch in two) and eight others were clear forearm fractures. Six patients had wrist fractures while the rest of the errors involved a variety of other injuries.
Given that musculoskeletal injuries account for a substantial proportion of most doctors’ workloads, author Dr H.R. Guly called for better training of doctors to better meet patients’ needs (Emerg Med J, 2002; 19: 41-2).