title: Diagnosing fractures: pain intensity and subjective functional impairment are unreliable markers for initial assessment of possible extremity fractures.
abstract: OBJECTIVE
  The triage of trauma patients is based on patient-given information. The aim of the study was the accuracy of pain intensity, subjective functional impairment, trauma history, and clinical examination in identifying patients with fractures.
  
  
  METHODS
  We prospectively asked 436 patients with an extremity trauma whether they believed they had a fracture. Pain intensity and subjective functional impairment were also assessed. The physicians were also asked, based on trauma history and clinical examination.
  
  
  RESULTS
  The sensitivity and specificity of patient opinion and of the functional questions for fracture detection were low. The combination of history and clinical examination delivered the best results. There was only a slight difference in pain intensity between patients with and those without fractures.
  
  
  CONCLUSIONS
  Fracture diagnosis based only on patient opinion or subjective functional impairment can be misleading. Pain intensity needs further investigation for its role in fracture detection.
authors.affiliation: aCenter for Musculoskeletal Surgery bBerlin-Brandenburg Center for Regenerative Therapies/BRST cDepartment of Emergency Medicine, Trauma Wing dDepartment of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Serafim
authors.initials: S
authors.lastname: Tsitsilonis
authors.forename: Tobias
authors.initials: T
authors.lastname: Lindner
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Haas
authors.forename: Franziska M
authors.initials: FM
authors.lastname: Hahn
authors.forename: Tim
authors.initials: T
authors.lastname: Marnitz
authors.forename: Florian
authors.initials: F
authors.lastname: Wichlas
mesh_terms: D059787:Acute Pain / Q000209:etiology; D000328:Adult; D001134:Arm Injuries / Q000150:complications / Q000175:diagnosis; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007869:Leg Injuries / Q000150:complications / Q000175:diagnosis; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods