Pattern Analysis
Discover diagnostic confusion patterns and insights across 847 Salter-Harris cases
23
Patterns Identified
18.3%
Overall Misdiagnosis Rate
8.2 days
Avg. Diagnosis Delay
Type I
Most Commonly Missed
🗺️ Confusion Matrix: SH Type vs. Anatomical Location
Misdiagnosis frequency heatmapType I
Type II
Type III
Type IV
Type V
Distal Radius
45
12
8
3
2
Distal Tibia
28
15
22
9
6
Distal Fibula
67
18
11
7
4
Prox. Humerus
14
9
5
19
8
Distal Femur
11
4
7
12
38
0-5 cases
6-15 cases
16-30 cases
31-50 cases
50+ cases
Misdiagnosis Rate by SH Type
Diagnosis Delay Distribution
🔬 Top Confusion Patterns
Ranked by frequency1
Subtle Physeal Widening Overlooked
Minimal widening of the physis (1-3mm) not recognized without comparison views, leading to missed Type I fractures
234
27.6% of cases
2
Comparison Views Not Obtained
Bilateral comparison radiographs not ordered despite clinical suspicion of physeal injury
189
22.3% of cases
3
Type I Mistaken for Soft Tissue Injury
Normal-appearing radiograph leads to sprain/strain diagnosis when Type I fracture is present
156
18.4% of cases
4
Soft Tissue Swelling Undervalued
Significant soft tissue swelling present but not weighted appropriately in clinical decision making
143
16.9% of cases
5
Type V Diagnosed Retrospectively
Compression injuries only identified after growth arrest or angular deformity develops months later
98
11.6% of cases
6
Normal Ossification Variants Confuse
Normal developmental variants mistaken for fractures or fractures dismissed as normal variants
87
10.3% of cases
📋 Pattern Details
Subtle Physeal Widening Overlooked
Minimal widening of the physis (1-3mm) not recognized without comparison views, leading to missed Type I fractures.
High Impact
234 cases affected
Typical Diagnostic Journey
Present
X-ray
Missed
Return
Dx
Average delay: 9.2 days
Affected SH Types
Contributing Factors
No comparison views obtained
89%
Suboptimal image quality
34%
Busy ED environment
28%
Limited pediatric experience
21%
Recommendations
Always obtain bilateral comparison views in pediatric wrist and ankle injuries
Consider physeal injury when point tenderness exists over growth plate
Low threshold for follow-up imaging if symptoms persist beyond 5-7 days
Example Cases
View All 234 Cases
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