title: Bone scan as a screening test for missed fractures in severely injured patients.
abstract: BACKGROUND
  In many cases, patients with severe blunt trauma have multiple fractures throughout the body. These fractures are not often detectable by history or physical examination, and their diagnosis can be delayed or even missed. Thus, screening test fractures of the whole body is required after initial management. We performed this study to evaluate the reliability of bone scans for detecting missed fractures in patients with multiple severe traumas and we analyzed the causes of missed fractures by using bone scan.
  
  
  OBJECTIVE
  A bone scan is useful as a screening test for fractures of the entire body of severe trauma patients who are passed the acute phase.
  
  
  METHODS
  We reviewed the electronic medical records of severe trauma patients who underwent a bone scan from September 2009 to December 2010. Demographic and medical data were compared and statistically analyzed to determine whether missed fractures were detected after bone scan in the two groups.
  
  
  RESULTS
  A total of 382 patients who had an injury severity score [ISS] greater than 16 points with multiple traumas visited the emergency room. One hundred and thirty-one patients underwent bone scan and 81 patients were identified with missed fractures by bone scan. The most frequent location for missed fractures was the rib area (55 cases, 41.98%), followed by the extremities (42 cases, 32.06%). The missed fractures that required surgery or splint were most common in extremities (11 cases). In univariate analysis, higher ISS scores and mechanism of injury were related with the probability that missed fractures would be found with a bone scan. The ISS score was statistically significant in multivariate analysis.
  
  
  CONCLUSIONS
  Bone scan is an effective method of detecting missed fractures among patients with multiple severe traumas.
  
  
  METHODS
  Level IV, retrospective study.
authors.affiliation: Division of Trauma, Department of Surgery, Ajou University School of Medicine, San-5, Wonchon-dong, Yeoungtong-gu, Suwon 443-749, Republic of Korea. Electronic address: drkjlee@ajou.ac.kr.
authors.forename: K-J
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Division of Trauma, Department of Surgery, Ajou University School of Medicine, San-5, Wonchon-dong, Yeoungtong-gu, Suwon 443-749, Republic of Korea. Electronic address: jake98@daum.net.
authors.forename: K
authors.initials: K
authors.lastname: Jung
authors.affiliation: Division of Trauma, Department of Surgery, Ajou University School of Medicine, San-5, Wonchon-dong, Yeoungtong-gu, Suwon 443-749, Republic of Korea. Electronic address: trauma@ajou.ac.kr.
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Trauma, Department of Surgery, Ajou University School of Medicine, San-5, Wonchon-dong, Yeoungtong-gu, Suwon 443-749, Republic of Korea. Electronic address: aquaestel@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Kwon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Bone scan; Diagnosis; Missed fracture; Trauma