XXXX : an analysis of factors in cases of known delayed diagnosis and methods for improving identification.

@entity1 @entity174 @entity1230 @entity2720 @entity130 @entity3029
Because of the complex anatomy of the foot, rarity of @entity174 of the foot, and subtle radiographic cues, foot injuries are commonly overlooked and mis/undiagnosed. This study seeks to investigate a @entity1 population whose @entity130 , including @entity174 and @entity3029 , were missed on initial examination, in order to analyze factors of known, missed injuries and provide insight into methods for reducing the incidence of missed diagnoses. Surgical cases between January 1999 and May 2011 were queried and retrospectively reviewed to identify missed @entity130 . Of 1682 surgical cases reviewed, 27 @entity1 with @entity130 (ies), which were subsequently confirmed by imaging studies, were identified. Using the Orthopaedic @entity130 Association classification, @entity174 and dislocation subtypes were classified. A medical record review was performed to assess demographic and surgical data elements. In this study population, 7 types of @entity130 (talus, calcaneal, navicular, and @entity174 as well as subtalar, calcaneocuboid, and @entity2720 ) were diagnosed in 27 @entity1 . All @entity1 required surgical intervention. @entity174 were the most commonly missed injury. In @entity1 with @entity1230 , there was a strong correlation between talus and navicular @entity174 (r = -0.60; P < .01) as well as a moderate correlation between talus @entity174 and @entity3029 (r = -0.46; P = .02). The presence of a calcaneal @entity174 significantly decreased the time to definitive diagnosis (P = .01). Male @entity1 ' diagnoses were delayed an average of 324 days and females 105 days (P = .04). A moderate correlation was found between @entity1 age at injury and time to diagnosis (r = -0.47; P = .04), with a decreased time to diagnosis as @entity1 age increased. Significant factors were identified in this @entity1 population, including @entity1 sex and age, which may contribute to missed or delayed diagnosis in the clinical setting. Prompt and accurate diagnosis of @entity130 may improve long-term outcomes. LEVELS OF EVIDENCE: Care Management, Level V.
