Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre
| Autor: | Christopher Watura, Dylan Griffiths, Dimitri Amiras, Nicola Torr, Alex Peter Magnussen, Miny Walker |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Leadership and Management Quality Improvement Report Radiography continuous quality improvement Guidelines as Topic diagnostic errors 030218 nuclear medicine & medical imaging surgery 03 medical and health sciences Patient safety 0302 clinical medicine Trauma Centers London medicine patient safety Humans Protocol (science) Missed Diagnosis business.industry Health Policy Major trauma General surgery Shoulder Dislocation Fracture Dislocations Public Health Environmental and Occupational Health Emergency department Middle Aged medicine.disease Quality Improvement medicine.anatomical_structure 030220 oncology & carcinogenesis Upper limb Female teamwork business Emergency Service Hospital Posterior shoulder |
| Zdroj: | BMJ Open Quality |
| Popis: | BackgroundA high incidence of missed posterior shoulder dislocations is widely recognised in the literature. Concern was raised by the upper limb multidisciplinary team at a London major trauma centre that these missed injuries were causing serious consequences due to the need for surgical intervention and poor functional outcome.ObjectiveTo identify factors contributing to missed diagnosis and propose solutions.MethodsA local quality improvement report was performed investigating time from admission to diagnosis of simple posterior dislocations and fracture dislocations over a 5-year period. Factors contributing to a delayed diagnosis were analysed.ResultsThe findings supported current evidence: a posterior shoulder dislocation was more often missed if there was concurrent fracture of the proximal humerus. Anteroposterior and scapular Y view radiographs were not always diagnostic for dislocation. Axial views were more reliable in assessment of the congruency of the joint and were associated with early diagnosis and appropriate treatment of the injury.DiscussionAs a result of these findings a new protocol was produced by the orthopaedic and radiology departments and distributed to our emergency department practitioners and radiography team. The protocol included routine axial or modified trauma axial view radiographs for all patients attending the emergency department with a shoulder injury, low clinical suspicion for dislocation and a low threshold for CT scan. Reaudit and ongoing data collection have shown significant increase in axial view radiographs and improved diagnosis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|