An analysis of missed injuries in patients with severe trauma

Abstract

Purpose:To analyze the data of trauma patients with undetected injuries at the time of initial resuscitation during the primary and secondary surveys. Methods: We retrospectively reviewed the medical records of 807 patients who were hospitalized at the National Trauma Center, Seoul, Korea from June 1, 2019 to June 30, 2021. Results: In trauma patients with an Injury Severity Score ≥16 accounted for 27.5% in the non-missed injury group (non-MIG), but this rate was considerably higher at 71.2% in MIG. The mean hospitalization longer in MIG (50.90±39.56) than in non-MIG (24.74±26.11). The proportion of patients with missed injuries detected through tertiary trauma survey (TTS) was 28 patients (23.5%) within 24 hours, 90 patients (75.6%) after 24 hours to before discharge. The majority of missed injuries were fractures (82.4%) and ligament tears (8.4%), which required consultation with the orthopedic department. The final diagnoses of missed injuries were confirmed by computed tomography (44.5%), magnetic resonance imaging (19.3%), X-ray (19.3%), bone scan (11.8%), and physical examination (5.0%). Conclusions: TTS is considered a useful process for detecting missed injuries that were not identified at the time of initial resuscitation in the primary and secondary surveys. In the future, to detect missed injuries quickly, it is necessary to develop a suitable TTS program for each trauma center. In addition, further research is needed to verify the effectiveness of the protocolized TTS and survey chart to improve the effectiveness of TTS.

Tertiary Trauma Survey on Emergency Department Observational Units: A Systematic Literature Review

“…In this study, the detection rate of type-I DDIs was 3.1% (n=12), of which four patients had clinically significant missed injuries (CSMI). TTS was strictly carried out at 24 hours in seven (47%) of the studies on 10399 patients, Figure 2 [ 5 , 10 , 13 , 15 , 21 , 24 , 26 ]. Five of the studies reported type-I DDI in terms of the number of patients, with a detection rate of 1.9% in 10193 patients [ 5 , 10 , 13 , 15 , 24 ], while one reported type-I DDIs as 173 injuries at a detection rate of 56% [ 26 ].…”

“…TTS was strictly carried out at 24 hours in seven (47%) of the studies on 10399 patients, Figure 2 [ 5 , 10 , 13 , 15 , 21 , 24 , 26 ]. Five of the studies reported type-I DDI in terms of the number of patients, with a detection rate of 1.9% in 10193 patients [ 5 , 10 , 13 , 15 , 24 ], while one reported type-I DDIs as 173 injuries at a detection rate of 56% [ 26 ]. Due to heterogeneity in methodology and outcome assessment, comprehensive statistical analysis is not possible (Figure 3 ).…”

“…Most of the studies were conducted on ICU patients or those patients with significant and life-threatening injuries. Due to the severity of initial injuries, prioritization of management, and distraction, the number of missed injuries detected at TS in these patients is much higher [ 10 , 12 , 15 , 22 , 24 , 27 ]. Although this result is not relevant to the EDOU cohort, it emphasizes the importance of TTS in all polytrauma patients.…”

“…This high number could be due to a difference in the injury patterns and initial management priorities. Another more recent retrospective analysis by Ju et al, 2022, shows a significantly high rate of DDIs, 23.5% on a 24-hour TTS in patients with severe trauma [ 10 ]. The lower rate of DDIs in comparison to the earlier study by Janjua et al, 1998 could be due to the advancements in trauma management over the last two decades.…”

“…Most studies also concluded satisfactorily that standardized TTS at 24 hours gives better outcomes and is a cost-effective, easy, and efficient tool [ 10 - 12 , 22 - 24 , 27 ].…”