• Eur J Emerg Med · Apr 2016

    Diagnosing fractures: pain intensity and subjective functional impairment are unreliable markers for initial assessment of possible extremity fractures.

    • Serafim Tsitsilonis, Tobias Lindner, Norbert P Haas, Franziska M Hahn, Tim Marnitz, and Florian Wichlas.
    • aCenter for Musculoskeletal Surgery bBerlin-Brandenburg Center for Regenerative Therapies/BRST cDepartment of Emergency Medicine, Trauma Wing dDepartment of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
    • Eur J Emerg Med. 2016 Apr 1; 23 (2): 155-8.

    ObjectivesThe triage of trauma patients is based on patient-given information. The aim of the study was the accuracy of pain intensity, subjective functional impairment, trauma history, and clinical examination in identifying patients with fractures.MethodsWe prospectively asked 436 patients with an extremity trauma whether they believed they had a fracture. Pain intensity and subjective functional impairment were also assessed. The physicians were also asked, based on trauma history and clinical examination.ResultsThe sensitivity and specificity of patient opinion and of the functional questions for fracture detection were low. The combination of history and clinical examination delivered the best results. There was only a slight difference in pain intensity between patients with and those without fractures.ConclusionFracture diagnosis based only on patient opinion or subjective functional impairment can be misleading. Pain intensity needs further investigation for its role in fracture detection.

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