title: Radiology of Fractures in Intoxicated Emergency Department Patients: Locations, Mechanisms, Presentation, and Initial Interpretation Accuracy.
abstract: The purpose of this study was to investigate the relationship of alcohol intoxication to time-to-presentation following injury, fracture type, mechanism of injury leading to fracture, and initial diagnostic radiology interpretation performance of emergency physicians versus diagnostic radiologists in patients who present to the emergency department (ED) and are subsequently diagnosed with fracture. Medical records of 1286 patients who presented to the ED and were diagnosed with fracture who also underwent plain film or computed tomography (CT) imaging were retrospectively reviewed. The subjects were divided into intoxicated and sober groups. Patient characteristics, injury-to-presentation time, fracture location, and discrepancies between initial clinical and radiological evaluations were compared. Of 1286 subjects, 181 patients were included in the intoxicated group. Only intoxicated patients presented with head/neck fractures more than 24 hours after injury. The intoxicated group showed a higher rate of head/neck fractures (skull 23.2% vs 5.8%, face and orbit 30.4% vs 9.5%; P < 0.001) and a lower rate of extremity injuries. The rate of nondiagnosis of fractures by emergency physicians later identified by radiologists was the same in both groups (7.7% vs 7.7%, P = 0.984). While the same proportion of intoxicated patients presented more than 24 hours following injury, only intoxicated patients presented with craniofacial and cervical spinal fractures during this period. Alcohol-related injuries are more often associated with head/neck fractures but less extremity injuries. The rate of fractures missed by emergency physicians but later diagnosed by radiologists was the same in intoxicated and sober patients.
authors.affiliation: From Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (YM, TN, JS, YO, MM, YS, YK); Department of Radiological Sciences, University of California Irvine, Irvine, California (TN, HY); Department of Radiology, University of California San Francisco, San Francisco, California (JS); and Center for Clinical Epidemiology, St. Luke's Life Science Institute, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (SO).
authors.forename: Yuka
authors.initials: Y
authors.lastname: Morita
authors.forename: Taiki
authors.initials: T
authors.lastname: Nozaki
authors.forename: Jay
authors.initials: J
authors.lastname: Starkey
authors.forename: Yuka
authors.initials: Y
authors.lastname: Okajima
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ohde
authors.forename: Masaki
authors.initials: M
authors.lastname: Matsusako
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshioka
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Saida
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kurihara
mesh_terms: D000435:Alcoholic Intoxication / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed