A retrospective survey of 327 patients with multiple injuries was done to establish the incidence of missed injuries and the reasons for diagnostic failures. Of the patients, 12% had an injury not diagnosed at the 1st examination. The most vulnerable group were motorcyclists in whom the incidence was 23%. Missed injuries tended to be grouped about the major joints. Factors which predisposed to an inadequate initial assessment were poor clinical routine, failure to interpret correctly certain physical signs, poor utilization of X-ray services and, above all, admission of these patients to nonorthopedic wards.