title: Incidence of delayed and missed diagnoses in whole-body multidetector CT in patients with multiple injuries after trauma.
abstract: BACKGROUND
  Whole-body CT (WBCT) is the imaging modality of choice during the initial diagnostic work-up of multiple injured patients in order to identify serious injuries and initiate adequate treatment immediately. However, delayed diagnosed or even missed injuries have been reported frequently ranging from 1.3% to 47%.
  
  
  OBJECTIVE
  To highlight commonly missed lesions in WBCT of patients with multiple injuries.
  
  
  METHODS
  A total of 375 patients (age 42.8 ± 17.9 years, ISS 26.6 ± 17.0) with a WBCT (head to symphysis) were included. The final CT report was compared with clinical and operation reports. Discrepant findings were recorded and grouped as relevant and non-relevant to further treatment. In both groups, an experienced trauma radiologist read the CT images retrospectively, whether these lesions were missed or truly not detectable.
  
  
  RESULTS
  In 336 patients (89.6%), all injuries in the regions examined were diagnosed correctly in the final reports of the initial CT. Forty-eight patients (12.8%) had injuries in regions of the body that were not included in the CT. Fourteen patients (3.7%) had injuries that did not require further treatment. Twenty-five patients (6.7%) had injuries that required further treatment. With secondary interpretation, 85.4% of all missed lesions could be diagnosed in retrospect from the primary CT data-set. Small pancreatic and bowel contusions were identified as truly non-detectable.
  
  
  CONCLUSIONS
  In multiple traumas, only a few missed injuries in initial WBCT reading are clinically relevant. However, as the vast majority of these injuries are detectable, the radiologist has to be alert for commonly missed findings to avoid a delayed diagnosis.
authors.affiliation: Department of Clinical Radiology, University Hospitals LMU Munich lucas.geyer@med.lmu.de.
authors.forename: Lucas L
authors.initials: LL
authors.lastname: Geyer
authors.affiliation: Department of Clinical Radiology, University Hospitals LMU Munich.
authors.forename: Markus
authors.initials: M
authors.lastname: Körner
authors.affiliation: Department of Clinical Radiology, University Hospitals LMU Munich.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Linsenmaier
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich.
authors.forename: Stefan
authors.initials: S
authors.lastname: Huber-Wagner
authors.affiliation: Department of Surgery, University Hospitals LMU Munich, Germany.
authors.forename: Karl-Georg
authors.initials: KG
authors.lastname: Kanz
authors.affiliation: Department of Clinical Radiology, University Hospitals LMU Munich.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: Department of Clinical Radiology, University Hospitals LMU Munich.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirth
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D051598:Whole Body Imaging / Q000379:methods*
keywords: MDCT; delayed diagnosis; missed injuries; multiple trauma; whole-body CT