Satisfaction of search in multitrauma patients: Severity of detected fractures

Rationale and Objectives. Satisfaction of search (SOS) occurs when an abnormality is missed because another abnormality has been detected. This research studied whether the severity of a detected fracture determines whether subsequent fractures are overlooked. Materials and Methods. Each of 70 simulated multitrauma patients presented examinations of three anatomic areas. Readers evaluated each patient under two experimental conditions: when the images of the first anatomic area included a fracture (the SOS condition), and when it did not (the control condition). The SOS effect was measured on detection accuracy for subtle test fractures presented on examinations of the second and third anatomic areas. In an experiment with 12 radiology readers, the initial SOS radiographs showed nondisplaced fractures of extremities, fractures associated with low morbidity. In another experiment with 12 different radiology readers, the initial examination, usually a computed tomography scan, showed cervical and pelvic fractures of the type associated with high morbidity. Because of their more direct role in patient care, the experiment using high morbidity SOS fractures was repeated with 17 orthopedic readers. Results. Detection of subtle test fractures was substantially reduced when fractures of low morbidity were added (P < .01). No similar SOS effect was observed in either experiment in which added fractures were associated with high morbidity. Conclusions. The satisfaction of search effect in skeletal radiology was replicated, essentially doubling the evidence for SOS in musculoskeletal radiology, and providing an essential contrast to the absence of SOS from high-morbidity fractures.