A Prospective Evaluation of Missed Injuries in Trauma Patients, Before and After Formalising the Trauma Tertiary Survey

Abstract

ObjectiveThis study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure. MethodsProspective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March–October 2009 (preformalisation of TTS) and December 2009–September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months. ResultsA total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P < 0.001). Functional outcomes for both cohorts were similar at 1 and 6 months follow-up.ConclusionsThis is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.

Maxillofacial and concomitant serious injuries: An eight-year single center experience

“…Even if the incidence of clinically significant missed injuries is unknown, they are more likely to lead to prolonged morbidity or mortality. Although mortality as a result of missed injuries is rare, a prospective study indicated that approximately 1% of the cohort required a surgical intervention for injuries detected after the hospital discharge 35 . Injuries are often neglected during the primary and secondary surveys in trauma patients; namely, studies have suggested that a formal tertiary survey protocol lowers the number of missed injuries.…”

Office hours vs after-hours. Do presentation times affect the rate of missed injuries in trauma patients?

“…The Australian Safety and Quality Goals for Health Care Consultation in February 2012 [8] reported that on average 2.5 errors occur nationwide during the treatment of severely injured patients. A study from Queensland, Australia published in 2014 estimated the average missed injury rate to be between 3.8 and 4.8% [9]. The low incidence in our study can be explained by the fact that RPH is a Level 1 Centre for adults in Western Australia with senior Trauma cover available till 11 PM on weekdays.…”

Propusti u zbrinjavanju politraumatizovanog pacijenta

“…Kod dijafragmalnih I retroperitonealnih povreda i perforacija šupljih organa on je često lažno negativan. 12 Povrede dijafragme mogu biti asimptomatske a nalaz radiografije grudne duplje uredan. Zato je potrebno sprovesti rutinsku laparoskopiju kod svih pacijenata sa penetrantnom povredom leve ili prednje desne torakoabdominalne regije čak i u odsustvu simptoma.…”