Easily missed pathologies of the musculoskeletal system in the emergency radiology setting

Abstract

Background

The musculoskeletal region is the main area in terms of easily missed pathologies in the emergency radiology setting, because the majority of diagnoses missed in the emergency setting are fractures.

Method

A review of the literature was performed by searching the PubMed and ScienceDirect databases, using the keywords (‘missed injuries’ or ‘missed fractures’) and (‘emergency radiology’ or ‘emergency room’) and (‘musculoskeletal’ or ‘bone’ or ‘skeleton’) for the title and abstract query. The inclusion criteria were scientific papers presented in the English and German languages. Among the 347 relevant hits between 1980 and 2024 as identified by the author of this review article, there were 114 relevant articles from the years between 2018 and 2024. Based on this literature search and the author’s personal experience, this study presents useful information for reducing the number of missed pathologies in the musculoskeletal system in the emergency radiology setting.

Results and Conclusion

Predominant factors that make up the majority of missed fractures are ‘subtle but still visible fractures’ and ‘radiographically imperceptible fractures’. Radiologists are able to minimize the factors contributing to fractures being missed. For example, implementing a ‘four-eyes principle’, i.e., two readers read the radiographs, would help to overcome the missing of ‘subtle but still visible fractures’ and the additional use of cross-sectional imaging would help to overcome the missing of ‘radiographically imperceptible fractures’. Knowledge of what is commonly missed and evaluation of high-risk areas with utmost care also increase the diagnostic performance of radiologists.

Key Points

• Radiological imaging in an emergency setting increases the likelihood of radiological diagnostic errors, such as missing musculoskeletal pathologies.

• The majority of diagnoses missed in the emergency setting are fractures.

• To lessen the number of easily missed pathologies in the musculoskeletal system in the emergency radiology setting, a systematic approach is necessary.

• Adequate training of radiologists in emergency radiology and close collaboration with clinical partners are important measures to decrease the number of missed musculoskeletal injuries.

Citation Format

• Weber MA. Easily missed pathologies of the musculoskeletal system in the emergency radiology setting. Rofo 2025; DOI 10.1055/a-2369-8330

Zusammenfassung

Hintergrund

Der muskuloskelettale Bereich spielt die Hauptrolle, wenn es um leicht zu übersehende Pathologien in der Notfallradiologie geht, da es sich bei den meisten Diagnosen, die in der Notfallradiologie übersehen werden, um Frakturen handelt.

Methode

Eine Literaturrecherche wurde durch Durchsuchen der Datenbanken PubMed und ScienceDirect unter Verwendung der Schlüsselwörter in Titel und Abstract (,missed injuries‘ oder ,missed fractures‘) und (,emergency radiology‘ oder ,emergency room‘) und (,musculoskeletal‘ oder ,bone‘ oder ,skeleton‘) durchgeführt. Einschlusskriterien waren wissenschaftliche Arbeiten, die in englischer und deutscher Sprache vorlagen. Unter den 347 relevanten Treffern von 1980 bis 2024, die der Autor dieses Übersichtsartikels identifizierte, stammen 114 relevante Artikel aus den Jahren 2018 bis 2024. Aus dieser Literaturrecherche und aus der persönlichen Erfahrung des Autors werden in diesem Beitrag nützliche Hinweise gegeben, um die Zahl der übersehenen Pathologien des Bewegungsapparates in der Notfallradiologie zu reduzieren.

Ergebnisse und Schlussfolgerung

Die vorherrschenden Faktoren, die die Mehrzahl der übersehenen Frakturen ausmachen, sind die „subtilen, aber immer noch sichtbaren Frakturen“ und an zweiter Stelle die „röntgenologisch nicht wahrnehmbaren Frakturen“. Radiologen sind in der Lage, die Ursachen zu verringern, die zu übersehenen Frakturen beitragen. Beispielsweise könnte die Umsetzung eines „Vier-Augen-Prinzips“, d.h. zwei Beobachter lesen die Röntgenbilder, dazu beitragen, dass Übersehen der „subtilen, aber dennoch sichtbaren Frakturen“ zu vermeiden, und der zusätzliche Einsatz von Schnittbildgebung würde helfen, um „röntgenologisch nicht wahrnehmbare Frakturen“ zu erkennen. Das Wissen darüber, was häufig übersehen wird, und die Bewertung von Hochrisikobereichen mit höchster Aufmerksamkeit steigern zudem die diagnostische Leistung der Radiologen.

Kernaussagen

• Die radiologische Notfalldiagnostik erhöht die Wahrscheinlichkeit radiologischer diagnostischer Fehler, wie etwa Pathologien des Bewegungsapparates zu übersehen.

• Bei den meisten in der Notfallversorgung übersehenen Diagnosen handelt es sich um Frakturen.

• Um die Anzahl leicht zu übersehender Pathologien des Bewegungsapparates in der Notfallradiologie zu verringern, ist ein systematischer Ansatz erforderlich.

• Eine angemessene Ausbildung von Radiologen in der Notfallradiologie und die enge Zusammenarbeit mit klinischen Partnern sind wichtige Maßnahmen, um die Zahl übersehener muskuloskelettaler Verletzungen zu verringern.

Keywords

fractures - missed diagnoses - musculoskeletal - emergency radiology

Publication History

Received: 18 April 2024

Accepted after revision: 11 July 2024

Article published online:
02 August 2024

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