Missed fractures resulting from satisfaction of search effect

Abstract

This study assessed whether subtle fractures are mised in multitrauma patients because other fractures are detected. Sixty-five simulated trauma patients were each depicted in series of radiographs that were assembled from radiographs of several actual patients. The radiographs were selected to look like they belonged to a single patient. Forty-six cases included a radiograph showing a subtle fracture (which we called the “target”). In one experimental condition, none of the other radiographs in the patient’s series contained a fracture. In a second experimental condition, a radiograph containing an additional fracture (called the “distracter”) was substituted for a radiograph that had no fracture in the first experimental condition. The accuracy of detecting the target fractures was significantly reduced for cases in which the distracter fracture was reported. Awareness of the nature of this type of miss may lead to realistic strategies to avoid it.