Of 53 claims involving facial trauma, 10 out of 69 named defendants were EPs, according to a recent analysis.1 Complaints of delay or failure to diagnose accounted for half these lawsuits. Lawsuits stemmed from a variety of issues, but when EPs were sued, it was usually for failure to diagnose a fracture.

“One of the main issues we found is someone comes in with an injury, and the emergency physician gets an X-ray but misses the fracture,” says Boris Paskhover, MD, one of the study’s authors and an assistant professor in the department of otolaryngology at Rutgers New Jersey Medical School. Often, the plaintiffs underwent an X-ray, which the EP or someone else read as negative. “But the honest truth is if you don’t do it often, you can easily miss a small fracture. Even a small fracture often needs some sort of management so it doesn’t become a big deal,” Paskhover explains. If missed, small, midfacial fractures typically heal with no major consequences.

“But the mandibular fractures have implications as a stress-bearing bone. If you miss a small fracture and it gets infected, you have consequences,” Paskhover cautions.

The one practice change EPs should consider, according to Paskhover, is that if there is suspicion of a fractured jaw, “a CT scan’s going to pick it up. An X-ray may not.” A recurring fact pattern in the lawsuits involved EPs who relied on the X-ray they (or someone else) misread as normal, without getting a CT scan. In some cases, patients themselves gave a clue that something was missed.

“If the X-ray is normal, and they still say something doesn’t feel right, scan them,” Paskhover says.


  1. Mozeika AM, Sachdev D, Asri R, et al. Sociological and medical factors influence outcomes in facial trauma malpractice. J Oral Maxillofac Surg 2019; Jan 15. pii: S0278-2391(19)30007-2. doi: 10.1016/j.joms.2019.01.005. [Epub ahead of print].