Diagnostic errors in orthopedic surgery: evaluation of resident documentation of neurovascular examinations for orthopedic trauma patients

Abstract

The need for accuracy in neurovascular examinations of the extremities of trauma patients is well recognized. The goals of this study were to (a) evaluate the completeness of orthopedic house staff documentation of the neurovascular status of adult patients with extremity trauma, (b) identify the frequency of individual element documentation, and (c) determine if completeness was related to experience. The trauma center's database was reviewed for patients with extremity injuries (June 2006 through January 2008). For 114 patients, the authors assessed the neurovascular examination documentation for completeness (sensory, motor function, and vascular elements) and "perfection" (complete bilateral elements), identified the frequency of individual element documentation, and determined the relationship of completeness to experience (Pearson correlation coefficients; significance, P ≤ .05). There was no complete (all elements) or perfect (complete bilateral) documentation. The element most often documented completely was the sensory examination. Increased examiner experience was significantly associated with decreased sensory and vascular documentation.