Detection of missed fractures of hand and forearm in whole-body CT in a blinded reassessment

BackgroundWe examined the visibility of fractures of hand and forearm in whole-body CT and its influence on delayed diagnosis. This study is based on a prior study on delayed diagnosis of fractures of hand and forearm in patients with suspected polytrauma.MethodsTwo blinded radiologists examined CT-scans of patients with fractures of hand or forearm that were diagnosed later than 24h after admission and control cases with unremarkable imaging of those areas. They were provided with clinical information that was documented in the admission report and were asked to examine forearm and hands. After unblinding, the visibility of fractures was determined. We examined if time of admission or slice thickness was a factor for late or missed diagnoses.ResultsWe included 72 known fractures in 36 cases. Of those 65 were visible. Sixteen visible fractures were diagnosed late during hospital stay. Eight more fractures were detected on revision by the radiologists. Both radiologists missed known fractures and found new fractures that were not reported by the other. Missed and late diagnoses of fractures occurred more often around 5pm and 1am. Slice thickness was not significantly different between fractures and cases with fractures found within 24h and those found later.ConclusionsThe number of late diagnosis or completely missed fractures of the hand and forearm may be reduced by a repeated survey of WBCT with focus on the extremities in patients with suspected polytrauma who are not conscious.Level of evidenceIII

Automated summary

The visibility of hand and forearm fractures in whole-body CT scans plays a significant role in the delayed diagnosis of such fractures. Late diagnoses or completely missed fractures were more common around 5 pm and 1 am. Slice thickness did not significantly affect the detection of fractures within or after 24 hours.