Injuries may not be detected for a variety of reasons. It is important to be aware of why important findings can be missed.


Patient factors that may contribute to a poor exam:

(1) intoxication

(2) combative or psychotic

(3) comatose or unable to give complaints

(4) dirty and foul-smelling


Conditions in the Emergency Department contributing to a poor exam:

(1) overcrowding

(2) critical cases present

(3) disaster


Failures on the physical examination:

(1) not carefully examining an area covered by hair

(2) not washing an area that is dirty

(3) not removing all clothing

(4) not examining under a dressing or cast

(5) not examining the genital region

(6) not performing a rectal exam

(7) not spending enough time

(8) fixating on an obvious injury or complaint

(9) ignoring some part of the exam


Failures on the imaging studies:

(1) wrong imaging study ordered

(2) failure to perform the necessary view to see an injury


To read more or access our algorithms and calculators, please log in or register.