Some studies have found that a significant number of misinterpretations occur during “off” hours, such as between 12 a.m. 6-9 Studies have been conducted to evaluate the reasons for these misinterpretations. 3-5 While there is no direct evidence that shows which specific missed radiographic findings are the most common, a common feature is that a significant number of misinterpretations are made by non-radiologists. 1,2 Analysis of medical legal cases has repeatedly shown that fractures are among the top six high-risk diagnoses and alleged missed fractures are the second highest payouts in malpractice litigation, comprising 20% of malpractice claims between 19, decreasing to 10% between 19. Misinterpretation of these studies is of great importance and a great source of medical error. Plain radiographs are commonly ordered for patients who arrive in the emergency department (ED), and interpretation of those radiographs is critical. Even though the image exists in black and white, with shades of gray, the important point is, do we recognize what it means? I hope you find this issue of Emergency Medicine Reports, which discusses some radiographic findings that have the potential to be missed or underappreciated, useful in your practice. Even more so when interpreting radiographs. The practice of medicine involves judgment, the weighing of possibilities and probabilities. “As the gods are my witness, I have seen things on subsequent viewing that I initially did not.” Sir William Osler (1849-1919), Aequanimitas, with Other Addresses, Teacher and Student “Errors in judgment must occur in the practice of an art which consists largely in balancing probabilities.”
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