Educational tales from the ED… the unstable spinal fracture we sent home

Summary

This is a story of a patient in whom the emergency department missed the same diagnosis twice, four years apart. The first occasion (prior to his diagnosis of ankylosing spondylitis) was understandable. The second was not.

As a result of this case, the hospital have changed their x-ray policy for non-traumatic back pain. They also want to share key learning points (the majority of which were due to lack of awareness about a relatively rare condition and its complications) as widely as possible, to help others avoid the same errors. 

This reflective learning features guest educator, Mr Gareth Dwyer (the patient).

About the author

Dr Linda Dykes is one of only a handful of doctors in the UK who are dual-qualified in both Emergency Medicine and General Practice. Even fewer remain active in both specialties and she is believed to be the only dual-qualified EM/GP in the UK who has also gained experience working in Acute Community Geriatrics, in a 'Hospital at home' service. Linda also spent two years working regular shifts in Ambulance Control and has dabbled in the development of telephone algorithms via a short secondment to NHS111 Cymru/Wales.