Gaze dwell times on acute trauma injuries missed because of satisfaction of search

Rationale and Objectives. The authors performed this study to determine whe ther satisfaction of search (SOS) errors in patients with multiple traumas are caused by faulty visual scanning, faulty recognition, or faulty decisio n making. Materials and Methods. A series of radiographs were obtained in patients wi th multiple traumas. Radiologists interpreted each series under two experim ental conditions: when the first radiograph in the series included a fractu re, and when it did not. In the first experiment, the initial radiographs s howed nondisplaced fractures of the extremities (minor fractures); in the s econd experiment, the initial radiographs showed abnormalities of greater c linical importance (major fractures), Each series also included a radiograp h with a subtle (test) fracture and a normal radiograph on which detection accuracy was measured. In each experiment, gaze dwell time was recorded as 10 radiologists reviewed images from 10 simulated cases of multiple trauma, Results. An SOS effect could be demonstrated only in the second experiment. Analysis of dwell times showed that search on subsequent radiographs was s hortened when the initial radiograph contained a fracture: however, the err ors were not based on faulty scanning. Conclusion. The SOS effect in musculoskeletal trauma is not caused by fault y scanning. Demonstration of an SOS effect on test fractures with major but not minor additional fractures suggests that detection of other fractures is inversely related to the severity of the detected fracture.