EMERGENCY RADIOLOGY: THE FAILURE TO DIAGNOSE UPPER EXTREMITY INJURIES

Course overview

The failure to correctly interpret plain radiographs represents a persistent patient safety and risk management issue. In general, ‘failure to diagnose’ lawsuits and complaints represent the largest group of claims against emergency and urgent care practitioners and are common complaints against primary care providers. The experiences of several large TSG Client Organizations confirm that the failure to properly interpret plain X-rays has been and remains a common cause of morbidity and litigation. The upper extremity accounts for up to one-third of ‘failure to diagnose’ cases. Practitioners must be highly skilled in the analysis of X-rays of the upper extremity. This activity is part of TSG’s Radiology Program. The activities included in the Radiology Program are designed to help practitioners in identifying the common radiology missed diagnoses; they include a series of instructive radiographs and test the practitioner for proficiency. In this activity, we focus on upper extremity facture types that are high risk for failure to diagnose. We provide practitioners with an opportunity to review a number of X-rays in order to improve comfort with and ability to diagnose upper extremity fractures and related injuries. After completing this activity, practitioners should be able to: apply knowledge of the classifications of shoulder fractures and common related soft tissue injuries to the evaluation of radiographs in order to correctly diagnose fracture type and related injuries; create an approach to the radiographic evaluation of the elbow that includes a search for the fat pads in order to improve diagnostic evaluation of elbow injuries; and employ strategies that assist in diagnosing supracondylar fractures, such as the use of the anterior humeral line.