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. HYPOTHESIS: 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. MATERIAL AND 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. DISCUSSION: Bone

scan is an effective method of detecting missed fractures among patients with

multiple severe traumas. LEVEL OF EVIDENCE: Level IV, retrospective study.