Title: The Silence of a Precarious Fracture: Road Traffic Accident in a Chronic Spinal Cord Injury Patient
Authors: Murtaza Rashid M.D*, Nabeel Al Ansari M.D, Mohammed Al Mogbil M.D
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.102
Abstract
Diagnostic errors continue to haunt the practice of medicine. Emergency Department is one of the high risk medical specialties. Understaffing and work load in Emergency Department add to the burden. Missed injuries are preventable and have impact on patients as well as on the healthcare workers. A 21 year old male patient known case of previous spinal cord injury presented to our Emergency Department after a Road Traffic Accident while he was driving a car with handheld device. He was admitted with a diagnosis of lung contusion. During inpatient course he developed hemoglobin drop. Upon further investigation a fracture of the femur neck was observed which was overlooked earlier. A thorough physical and a radiological examination remains an integral tool for the diagnosis of fractures in a multi-trauma patient. A high index of suspicion must be maintained in all multi-trauma patients. Injuries and fractures can be missed due to physician or patient causes. It is rather unlikely to miss a fracture in a conscious, and an alert patient with no neurological deficit. However, it demands a more rigorous and repeated head to toe examination and further diagnostic methods to rule out any missed fractures in patients with decreased level of consciousness or with a previous neurologic deficit due to inability to elicit pain. The main reason to study medical errors is to try to prevent them.
Keywords: Spinal Cord Injury, Multiple Trauma, Femur Fracture, Missed Fractures.
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Murtaza Rashid M.D
Department Of Emergency Medicine,
Royal Commission Hospital, Jubail, 31961
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