Incidence of Delayed Diagnosis of Orthopaedic Injury in Pediatric Trauma Patients

Podolnick, Jeremy D.; Donovan, Daniel S.; Atanda, Alfred

doi:10.1097/bot.0000000000000878

Cited by 5 publications

(8 citation statements)

References 15 publications

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“…It is worth mentioning that these missed injuries did not result in mortality in our study. Similar findings in multiple other studies have shown that none of the delayed diagnoses contributed to the overall morbidity and mortality of the patients [5,10,11,13,19,27]. Out of the 476 patients who had a head injury or TBI, eight (1.7%) patients had a missed injury detected later during the hospital course.…”

Section: Prevalence Of Missed Injuries In Saudi Arabiasupporting

confidence: 86%

“…In Giannakopoulos et al, the missed injury population had a significantly higher median length of ICU stay of nine (3.7-16.2) versus five (2-11) days [11]. Podolnick JD et al had shown that the median ICU length of stay for pediatric patients with a missed injury was two days versus one day for patients without a missed injury [27].…”

Section: Predictors Of Missed Injuriesmentioning

confidence: 99%

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Prevalence of Missed Injuries in Multiple Trauma Patients at a Level-1 Trauma Center in Saudi Arabia

Babtain¹,

Almalki²,

Asiri³

et al. 2023

Cureus

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BackgroundMissed injuries are defined as injuries neither detected in the emergency department (ED) nor after admission to the hospital. The objective of this research was to identify missed injury rates, contributing factors, and clinical outcomes. MethodsA total of 657 trauma patients' records were retrospectively reviewed after admission to King Abdulaziz Medical City (KAMC) during the period from January 2016 to December 2018. Patients' demographic characteristics, presence of a missed injury, and Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) were assessed. ResultsAmong 657 patients who were admitted to our emergency department, only 11 (1.7%) patients were reported to have a missed injury during the hospital stay. None of those missed injuries contributed to the overall mortality. Higher GCS is a protective factor for missed injury with OR=0.12-0.81 and p-value=0.01. RTS and intensive care unit (ICU) stays were borderline although p-value=0.05 and OR=9 for RTS. Both longer ICU stays and high RTS were related to a higher risk of missed injury. ConclusionIn our study, the prevalence of missed injuries was on the lower end of the spectrum in comparison to multiple published data. The most common missed injuries were fractures and joint dislocations of extremities. None of those missed injuries were life-threatening or contributed to overall mortality. Higher GCS was a protective factor against missed injuries while high RTS and longer ICU stays were related to a higher likelihood of developing missed injuries during the hospital course.

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Section: Prevalence Of Missed Injuries In Saudi Arabiasupporting

confidence: 86%

Section: Predictors Of Missed Injuriesmentioning

confidence: 99%

Prevalence of Missed Injuries in Multiple Trauma Patients at a Level-1 Trauma Center in Saudi Arabia

Babtain¹,

Almalki²,

Asiri³

et al. 2023

Cureus

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“…23 Literatürde tanısal gecikme ile ilişkili görünen tekrarlayan faktörler, travmanın şiddetinin arttığı (ISS>15, injury severity score) yaralanma şiddeti skorunun yüksek olduğu durumlar ve hastanın mental durumunun kötüleşmesidir (Glaskow Koma Skalası <15). 24,25 Trafik ve motorlu araç kazalarında yaralanan hastalarda tanı atlama insidansının daha yüksek olduğu rapor edilmiştir. 26,27 hatalarıdır.…”

Section: Hasta Ile Ilgili Faktörlerunclassified

“…Glaskow Koma Skalası <15) 24,25. Trafik ve motorlu araç kazalarında yaralanan hastalarda tanı atlama insidansının daha yüksek olduğu rapor edilmiştir 26,27.…”

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Acil Serviste Atlanan Kırık ve Çıkıklarda Tanısal Zorluklar ve Hatalar

Çolak¹

2019

Sakarya Medical Journal

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DERLEME / Review Öz Eksik veya hatalı tanı acil serviste sık karşılaşılan bir durumdur. Bir hastanın ilk muayenesinde konulamayan tanı daha sonraki süreçte tespit edilirse, atlanmış tanıdan bahsedilir. Bu çalışmanın amacı, kırık ve çıkıklarda tanı atlama ile ilgili literatürün gözden geçirilmesi ve konuya yönelik öneriler sunmaktır. Acil servislerde daha fazla sayıda hastanın daha tecrübeli doktorlar tarafından görülmesi ve tecrübesiz doktorların daha iyi denetlenmesi, doktorların çalışma ortam ve sürelerinin, uyku düzenlerinin optimal düzeyde olması sağlanmalıdır. Hataların azaltılması hedeflenerek eğitim programlarının uygunluğu ve kalitesi arttırılmalıdır. Dikkatli, detaylı öykü ve fizik muayene standardizasyonu sağlanmalıdır.

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“…[12][13][14]19,21,25,37 Medicaid/CHIP pediatric patients have been shown to wait 40 days longer for an appointment than those with private insurance, 8 which in orthopaedics has translated to more severe injury at time of surgery. 24,27,34 Meniscal tears account for one of the most common injuries among pediatric athletes. 50 The meniscus is integral to activity in children, playing a vital role in load bearing, load distribution, and overall knee stability, 14 with tears leading to significant long-term clinical effects.…”

mentioning

confidence: 99%

Public Insurance Status Negatively Affects Access to Care in Pediatric Patients With Meniscal Injury

Olson

Pandya

2021

Orthopaedic Journal of Sports Medicine

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Background: Non- and underinsured individuals experience poor access to care and treatment delays. Meniscal injury is a common reason for surgical intervention in the pediatric population, and delays in care can lead to progression of the tear and other associated problems. Purpose: To investigate the impact of insurance status on access to care and severity of meniscal injury in the pediatric population. Study Design: Cohort study; Level of evidence, 3. Methods: Enrolled in this study were 49 patients receiving care for a meniscal injury between 2016 and 2018 from a safety-net medical system that does not prioritize patients based on insurance status. The patients were stratified into those publicly insured and those privately insured. Access to care was measured as wait time to various points of care: initial injury to clinic, injury to magnetic resonance imaging (MRI), injury to surgery, clinic to MRI, clinic to surgery, and MRI to surgery. The severity of the meniscal tear was measured by findings at the time of arthroscopy, including the type of tear identified, surgery performed, and cartilage injury. Results: Publicly insured patients waited a mean 230 days longer (347 vs 117 days; P < .01) to undergo surgery after injury compared with privately insured patients. The mean wait times in all categories except time from MRI to surgery were significantly longer for publicly insured patients, including injury to clinic (212 vs 73 days; P < .01), injury to MRI (260 vs 28 days; P < .001), injury to surgery (347 vs 117 days; P < .01), clinic to MRI (36 vs 3.9 days; P < .001), and clinic to surgery (136 vs 44 days; P < .01). Neither increased wait times nor insurance status were associated with greater surgical repair rate, severe tear type, or cartilage injury. Conclusion: Publicly insured pediatric patients waited significantly longer for a diagnosis of meniscal tear compared with privately insured patients, even in a safety-net setting. These delays were not associated with greater tear severity or cartilage changes. Providers in all models of care should recognize that insurance status and the socioeconomic factors it represents prevent publicly insured patients from timely diagnostic points of care and strive to minimize the resulting delayed return to normal activity as well as the potential long-term clinical effects thereof.

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Incidence of Delayed Diagnosis of Orthopaedic Injury in Pediatric Trauma Patients

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 5 publications

References 15 publications

Prevalence of Missed Injuries in Multiple Trauma Patients at a Level-1 Trauma Center in Saudi Arabia

Prevalence of Missed Injuries in Multiple Trauma Patients at a Level-1 Trauma Center in Saudi Arabia

Acil Serviste Atlanan Kırık ve Çıkıklarda Tanısal Zorluklar ve Hatalar

Public Insurance Status Negatively Affects Access to Care in Pediatric Patients With Meniscal Injury

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