Emergency Cases Northwest Group

006 Not a Fan of Hip-hop

Situation

A patient had sudden, severe sciatica. Turned out to be a pathological hip fracture.

Background

A 53 year old woman complained of severe, spontaneous, sudden pain the buttock radiating a little down the back of the leg. Exam revealed spasm like pain in the leg/hip. Paramedics diagnosed sciatica. Xray lumbar spine was normal. Much later hip xray eventually showed pathologic fracture.

Assessment

She was misdiagnosed initially as sciatica but it was a hip fracture all along.

Recommendation

Anchoring bias is when, apart from an initial diagnosis, other diagnoses are given little thought. Especially if another colleague has already applied a label to a patient.

Referred pain is a real symptom, such as from sciatica or diaphragmatic irritation. But look at, feel and move the bit that hurts to avoid a similar miss.

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group