创伤骨科急诊入院病人漏诊与误诊的分析

Analysis of Misdiagnosis and Missed Diagnosis in Traumatic Fractured Patients

目的探讨创伤骨科急诊入院病人漏误诊原因及防止措施。方法根据１９９７年１１０４例创伤骨科急诊入院病人的病历记录，对５７例６４处损伤初诊被漏诊或误诊进行统计分析，寻找与漏诊发生的相关因素。结果１１０４例创伤骨科急诊入院病人中，５７例６４处损伤初诊被漏诊或误诊，漏误诊率为５．１％。统计学检验发现较高ＩＳＳ评分、多发伤、车祸伤及坠落伤患者漏误诊的发生率较高。７８．１％的漏误诊是由于医师违反诊查常规或粗心大意造成，１０．９％的损伤以现有的常规检查难以发现。结论同一肢体多发伤中关节部位的损伤最容易发生漏误诊，初诊医师应按诊查常规操作，并注意系统全面的检查，部分病例应采用ＣＴ、骨扫描等更先进的诊查手段。

Objective To analyze the reasons for mis-or missed diagnosis in traumatic fractured patients and subsequently to find the possible measures to reduce them. Methods Out of the 1104 cases of traumatic fractures, 57 cases (64 fractures) were found being mis-or missed diagnosed and the relating factors were determined. Results Multiple injuries, traffic accident injuries, falling injuries, and high ISS score had a high occurrence of mis-or missed diagnosis. The reason was considered mainly due to inadequate assessment or negligence. Some injuries (10.9%) could not be found by routine approaches. Conclusions Multiple injuries consisted of joint injuries in the same extremity are apt to develop mis- or missed diagnosis. By careful physical and X-ray examination, most injuries can be found. To those injuries that can not be found by routine approaches, CT scaning, bone scanning and other advanced techniques should be used.