Satisfaction of search for subtle skeletal fractures may not be induced by more serious skeletal injury.

PURPOSE: The aim of this experiment was to test whether radiographs of major injuries, those having serious consequences for life and limb, produce a satisfaction-of-search (SOS) effect on the detection of subtle, nondisplaced test fractures.
METHODS: Institutional review board approval and informed consent from 24 participants were obtained. Seventy simulated patients with multiple trauma injuries were constructed from radiographs of 3 different anatomic areas demonstrated only skeletal injuries. Readers evaluated each patient under 2 conditions: first, in the non-SOS condition, no injuries were present in the first anatomic images, and second, in the SOS condition, the first anatomic images included major injuries requiring immediate medical intervention. The SOS effect was measured on detection accuracy using receiver operating characteristic analysis for subtle test fractures presented on examinations of the second or third anatomic areas.
RESULTS: Satisfaction-of-search reduction in receiver operating characteristic experiments for detecting subtle test fractures with the addition of a major injury was not observed.
CONCLUSIONS: Satisfaction of search was absent when major injuries were presented on radiographs. This finding rejects the hypothesis that SOS arises primarily from injuries requiring major intervention. Similar results have been found previously when major injuries were presented on CT but test fractures were presented on radiographs. This new finding rejects the possibility that SOS is absent because added and test fractures appear on different imaging modalities.