Satisfaction of search errors detecting subtle fractures diminish in the presence of more serious injuries

Satisfaction of search (SOS) occurs when an abnormality is missed because another abnormality has been detected in radiology examinations. This research includes our study of whether the severity of a detected fracture determines whether subsequent fractures are overlooked. Each of 70 simulated multitrauma patients presented radiographs of three anatomic areas. Readers evaluated each patient under two experimental conditions: when the images of the first anatomic area included a severe 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 or third anatomic areas. SOS reduction in ROC area for detecting subtle test fractures with the addition of a major fracture to the first radiograph was not observed. The same absence of SOS that had been observed when high-morbidity added fractures were presented on CT was replicated with the high-morbidity added fractures presented on radiographs. This finding rules out the possibility that there was no SOS in the prior study with CT because SOS effects do not extend from one imaging modality to another. Taken together, the evidence rejects the hypothesis that the severity of a detected fracture determines the SOS for subsequently viewed fractures.