To ask what you would have expected the hospital to do in this situation

[Mylandra]

I was recently involved in a major accident which resulted in a lot of trauma to my body. I was taken to hospital by ambulance, and taken straight in onto a bed. Whilst I was there, the nurse did an ECG, took my temperature and took some bloods. After 3 hours they sent me home

I was complaining of severe pain to my collarbone and ribs and also to both knees. The hospital didn’t do any x-rays or scans, just said everything seemed fine and sent me on my way. I was able to walk, so I didn’t think I’d done anything to my legs, but the pain in my chest has been getting worse, to the point it’s unbearable. I’ve since had to go back to another hospital where they did do x-rays, and it turned out I’ve broken 2 ribs and my collarbone

Aibu to wonder if they should have been doing all that the first time I was taken to hospital? I’ve never been before so I had no idea what to expect

Yes, they should have at least done an X-rays.
I hope you will pursue this as they need to know they failed you, and they need to do better for all who come behind you.

It’s difficult not know without having been there. In my hospital most ‘major’ road traffic crash patients get a full scan. Was this in the UK? We’re you actually seen by a Dr?

@Disfordragon it wasn’t a car accident, but similar level of impact I guess. It is in the UK, and I was seen by a dr right at the end who checked over my results and said I was fine to leave

I would have thought most hospitals would have done but equally has it made any difference to your treatment to know that you have broken ribs? There is no specific treatment for broken ribs so the treatment is the same if they are broken or just bruised ie analgesia. An X ray is a dose of radiation and sometimes radiologists are reluctant to do X rays that won't change management
Also just because this hospital did X Ray it doesn't mean the last one was wrong. The clinical situation is different because your pain has persisted. The last one didn't know that would happen. It might have gone away and since you would not miss out on any treatment as there is none it would be reasonable to wait
I do not think it was negligent not to X-ray on what you have said.

I'd have expected X-rays

@CovoidOfAllHumanity that’s a good explanation, thank you. I don’t think it would have made any difference, as like you said there’s nothing they could do. I was just a bit surprised at the time, and a few people have said the same, so I wondered what they would usually do in that situation

Well it might not make any difference not to have x-rayed for broken ribs but it absolutely may have made a difference re collarbones - sometimes they need an operation and pins which can be time sensitive so I definitely wouldn't be happy?!

You poor thing.
I would definitely have expected you to be xrayed. How can they know if you have broken anything without them??
Very odd.

I know it's difficult when you are the patient but if I wasn't getting what I expected I would ask. 'Oh are you not going to do any x rays to rule out fractures?' That way at least you would have an explanation. No one should mind explaining their management plan.

But you can tell by clinical examination if there's a displaced collar bone fracture that would require an operation. You wouldn't need an x Ray unless it was undisplaced and if it's undisplaced it doesn't need anything.

Ah, that's fair covoid! I think I am biased because my relative completely snapped their collarbone to the point where it popped in and out of their collar, had an X ray, they (somehow?!) Concluded it wasn't broken, sent him away so he didn't have any treatment and now still has a deformed shoulder!

Whilst a simple rib fracture is treated the same as bruising, surely they should x Ray to ensure that it is not a more complicated break where the bone could be causing issues etc

I disagree, and say you do need to know about broken ribs, so the patient can be aware of symptoms for complications such as a punctured lung and chest infection etc.

Look I think most people would X Ray but if clinical examination has ruled out major complications and the patient is well it would not be negligent not to do so
What about resource poor settings? Drs who work in settings where it's not so easy to 'just get an X-ray' learn how to manage
without. It was not in fact necessary for management in this case.
You can warn the patient what complications to look out for without an X-ray

Useless I hope your better now.

A hospital Miss my 3 year old broken arm Sent us home and then we ended up at the larger hospital in the night when he woke screaming.

It's appalling you told them you were experiencing severe pain and they didn't give you an X-ray and just sent you home? That's terrible. I would make a complaint about this. They didn't do a thorough job of checking you over when you were expressing your pain. Sounds like they needed the bed and just sent you away! That's really awful. I hope you're feeling better soon.

[quote Mylandra]@CovoidOfAllHumanity that’s a good explanation, thank you. I don’t think it would have made any difference, as like you said there’s nothing they could do. I was just a bit surprised at the time, and a few people have said the same, so I wondered what they would usually do in that situation[/quote]
Even if there is nothing they would do with broken ribs etc, that doesn't mean don't give you an X-ray to at least make you aware, provide appropriate pain relief etc. They cut corners big time.

X-ray at a minimum, CT ideally. Fractured ribs are generally treated in one way but the amount of damage and potential risk of complications actually varies depending on which ribs are fractured, how many ribs are fractured and if they have interfered with the integrity of the lung. How you are treated after is based on that.
So unless the Dr in ED had X-ray vision you should have been at a minimum, sent for a chest X-ray. The potential for complications post rib injury is significant, and for your own information now being able to breath effectively and cough well are incredibly important. Pain is the biggest factor so I hope you have good pain relief prescribed for you

If you fell off a horse, there is a lack of understanding of the forces involved (speed and height from which you fell) which is why equestrians are often dismissed post accident!

@CovoidOfAllHumanity can I ask what you would class as clinical examination?

Ex A&E nurse here. It would depend entirely on the accident you had as the 'mechanism of injury' dictates what the investigations are. If it was a fall from a ladder and you complained of pain in your chest and arm, then they would X-ray the appropriate areas. So without knowing how you injured yourself no one can say.

@inheritancetrack sorry I’ve just realised I didn’t say that! I was hit by a motorbike whilst I was using a crossing

Going by 24 hours in a and e, usually if its a major accident and someone has been brought in on a bed by an ambulance they do xrays and a ct or mri depending what the injuries could be relating to the accident.

Elderly DM had a fall during pandemic was taken to hospital in ambulance they did not X-ray her hip which turned out to be broken I was very angry as she was in agony

A clinical examination is taking a history to include the mechanism of injury, looking at the area for deformity, bruising etc, feeling for anything moving that shouldn't be, checking range of movement and pain on moving and breathing, listening to lungs
If the Dr did those kind of things and then decided not to order an X ray then that is not negligent. If they did just take one look then maybe it is. You can make a complaint via PALS and another Dr will review it but the fact of not having an X ray is not negligent in itself.