Clinical and Autopsy Analysis of Delayed Diagnosis and Missed Injuries in Trauma Patients

Abstract

Delayed diagnosis of injury (DDI) during hospitalization and missed injuries (MI) on autopsy in trauma deaths result in untoward outcomes. Autopsy is an effective educational tool for health care providers to evaluate trauma care. A retrospective study of trauma registry patients and coroner's records was categorized into groups 1 (alive patients) and 2 (trauma deaths) and analyzed. DDI incidence was similar in group 1 (1.8%) and group 2 (1.9%). Autopsy analysis (163 patients) yielded 139 MI in 94 patients (57.6%), <3 per cent of MI had negative impact on survival. Bony injuries comprised 68 per cent of DDI and 19 per cent of MI. Group 1 DDI patients were sicker with higher injury severity score (ISS: 16.07) than their cohorts (ISS 7.13, P value <0.05). These patients had higher Glasgow Coma Scale (14.41) and lower ISS (16.07) as compared with group 2 MI patients (ISS: 33.49, GCS: 6.45, P value <0.05). Autopsy rate was 99.5 per cent in trauma deaths, 57 per cent for nontrauma deaths, and 79 per cent for all deaths. Less than 3 per cent of MI had negative impact on survival. Routine ongoing patient assessment with pertinent diagnostic workup is essential in reducing DDI. Trauma autopsies reveal MI, which aid performance improvement (PI).

Quality Indicators for Evaluating Trauma Care

“…5 Cohort studies 18,50,128,199,204 ; 3 before-and-after case series 73,130,158 ; 2 case series 42,208 ; 1 nonrandomized controlled trial 93 ; 1 case-control study 9 ; 1 cross-sectional survey 156 ; and 1 consensus method 177 Unscheduled surgical treatment within X h (range, 24-48 h) of initial procedure 3 Cohort studies 7,107,128 ; 3 before-and-after case series 74,157,158 ; 3 case series 42,50,129 ; 1 case-control study 9 ; and 1 consensus method 177 Missed injuries, ie, injuries diagnosed/documented X h (range, 24 h to discharge) after admission 5 Cohort studies 7,107,128,161,169 ; 3 case series 34,50,152 ; 1 before-and-after case series 158 ; and 1 consensus method 177 Glasgow Coma Scale score ϽX (range, 8-10) and airway not secured within X (range, Ͻ5 min to before patient leaves the ED)…”

Pediatric trauma deaths are predominated by severe head injuries during spring and summer

“…Also, there are few studies including post-mortem examination in population-based trauma assessment overall, and particularly in the younger victims. This is likely reflecting a general reluctance to performing autopsy as it has raised controversy by its value for trauma care evaluation [ 16 - 18 ]. The aim of the current study was to investigate the death of children and adolescents after trauma in a defined population.…”

External injury documentation in major trauma victims is inadequate: Grounds for routine photography in the emergency department?

“…There have been numerous studies supporting the usefulness of autopsy data in trauma care, focusing mainly on missed injuries and incorrect diagnoses 8–10 . However, the main limitation of previous published work is that there is no widely accepted measurement of ED documentation.…”