This study is truly comprehensive and I commend you on your efforts. However, I do believe that a lack of EXPERIENCED doctors, as you mentioned once in the manuscript, are really the cause of misdiagnosed fractures. Also, you failed to include rib fractures and scaphoid fractures in your study. I feel that these two types of fractures should be included in your manuscript due to the fact that they are two of the most common types of fractures typically seen in a common Emergency Department. Also, I do believe that the cause of said fracture should be included in your data. Some fractures caused by difficult to diagnose pathologies can be easily overseen. For example, if a leg is broken due to an osteosarcoma, the fracture may be difficult to diagnose along with the condition itself. This study, however, is very competent and could be published in the Journal of the American Medical Association with the proper adjustments.
Competing interests
None declared
Authors' reply
Peter Hallas, .
3 August 2006
We thank Dr. Hopkins for the comments. There are indications in our study that many of the fractures simply were difficult to diagnose even for experienced doctors: a resident had been called by the intern to see the x-rays in 24 of the 61 cases of error (p<0.05) thus indicating that the intern on call was aware that interpretation the particular x-rays might be difficult. In addition several mistakes were made even when pictures had been reviewed by a consultant in orthopaedics.
We excluded scaphoid and rib fractures from the study because in some cases these fractures should be diagnosed on the basis of clinical examination alone even in the absence of a positive finding on the x-rays; thus based solely on the x-rays findings it would be misleading to claim that a diagnosis of one these fractures was false-positive.
Our showed that no specific anatomical region were especially at risk for misdiagnosis; however, the overall number of misdiagnosed fractures in our study was too small to address the question of trauma mechanisms and fracture types. We agree with Dr. Hopkins that it would be enlightening to see a study that identify if there are any specific fractures that are especially at risk of being misdiagnosed.
Peter Hallas
Trond Ellingsen
Competing interests
None declared
4 day delay in fracture diagnosis raises concern
Dustin Paz, California Department of Health
3 August 2006
I'm interested to know why the 'Correct diagnosis was delayed 3.9 days on average (s.d. 0.5; median 1 day)' I wonder what policy was in place to rectify the discrepancy, and if so what it was. 4 days seems like an extended amount of time to correctly interpret the study.
Experience and Cause
31 May 2006
This study is truly comprehensive and I commend you on your efforts. However, I do believe that a lack of EXPERIENCED doctors, as you mentioned once in the manuscript, are really the cause of misdiagnosed fractures. Also, you failed to include rib fractures and scaphoid fractures in your study. I feel that these two types of fractures should be included in your manuscript due to the fact that they are two of the most common types of fractures typically seen in a common Emergency Department. Also, I do believe that the cause of said fracture should be included in your data. Some fractures caused by difficult to diagnose pathologies can be easily overseen. For example, if a leg is broken due to an osteosarcoma, the fracture may be difficult to diagnose along with the condition itself. This study, however, is very competent and could be published in the Journal of the American Medical Association with the proper adjustments.
Competing interests
None declared
Authors' reply
3 August 2006
We thank Dr. Hopkins for the comments. There are indications in our study that many of the fractures simply were difficult to diagnose even for experienced doctors: a resident had been called by the intern to see the x-rays in 24 of the 61 cases of error (p<0.05) thus indicating that the intern on call was aware that interpretation the particular x-rays might be difficult. In addition several mistakes were made even when pictures had been reviewed by a consultant in orthopaedics.
We excluded scaphoid and rib fractures from the study because in some cases these fractures should be diagnosed on the basis of clinical examination alone even in the absence of a positive finding on the x-rays; thus based solely on the x-rays findings it would be misleading to claim that a diagnosis of one these fractures was false-positive.
Our showed that no specific anatomical region were especially at risk for misdiagnosis; however, the overall number of misdiagnosed fractures in our study was too small to address the question of trauma mechanisms and fracture types. We agree with Dr. Hopkins that it would be enlightening to see a study that identify if there are any specific fractures that are especially at risk of being misdiagnosed.
Peter Hallas
Trond Ellingsen
Competing interests
None declared
4 day delay in fracture diagnosis raises concern
3 August 2006
I'm interested to know why the 'Correct diagnosis was delayed 3.9 days on average (s.d. 0.5; median 1 day)' I wonder what policy was in place to rectify the discrepancy, and if so what it was. 4 days seems like an extended amount of time to correctly interpret the study.
Competing interests
None declared