Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients

Giannakópoulos, Georgios F.; Saltzherr, Teun Peter; Beenen, Ludo F. M.; Reitsma, Johannes B.; Bloemers, Frank W.; Goslings, J. C.; Bakker, Fred C.

doi:10.1016/j.injury.2011.07.012

Cited by 58 publications

(65 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One purpose of using a standardised approach is to minimise the incidence of missed injuries. However, despite all of the precautions, missed injuries continue to occur during initial assessment [2,14].…”

Section: Discussionmentioning

confidence: 99%

“…This has helped us increase the detection rate of missed injuries. The importance of tertiary surveys ever since its introduction by Enderson et al [2,15] in the early 90s cannot be underestimated. Following the initiation of SMTU, tertiary surveys were made mandatory on every patient.…”

Section: Discussionmentioning

confidence: 99%

“…However they may also be defined as injuries identified after a specific period of time such as 24 or 48 hours [1]. While there is no uniform definition of missed injuries, it is universally agreed that they can have a number of consequences including increased morbidity, increased length of hospital and/or ICU stay, additional surgical procedures, increased costs, litigations and even mortality [2,5]. In addition to the above they can lead to immense dissatisfaction on part of both the patient as well as the treating team, sometimes even overshadowing the life-saving efforts made by the trauma team [2] during the initial phase of resuscitation.…”

Section: Introductionmentioning

confidence: 99%

“…These include presence of life threatening injuries, severe traumatic brain injuries, high injury severity scores (ISS) and decreased level of consciousness [2,3]. Missed injuries have been a cause for concern to clinicians for several years and several diagnostic guidelines have been introduced to minimise the incidence of the above [2]. Background: A number of studies have investigated the effect of presentation time on the outcome of patients presenting following trauma.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Mazahir¹,

Pardhan²,

Rao³

2015

Injury

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Mazahir¹,

Pardhan²,

Rao³

2015

Injury

View full text Add to dashboard Cite

“…A liberal approach to imaging is taken for the multiply injured trauma patient, especially when the patient has altered sensorium secondary to head injury, alcohol, or drugs. This liberal approach stems from the fact that extremity fractures are the most commonly missed injuries in trauma patients even in the era of “pan-imaging.”[2122]…”

Section: Emergency Physician Perspectivementioning

confidence: 99%

The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Bach

Leskovan

Scharschmidt

et al. 2017

Int J Crit Illn Inj Sci

View full text Add to dashboard Cite

Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations.Republished with permission from:Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10.

show abstract

Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma

et al. 2020

View full text Add to dashboard Cite

Initial whole-body computed tomography (WBCT) for screening patients with suspected blunt multiple trauma remains controversial and a source of excess radiation exposure. OBJECTIVE To determine whether low-dose WBCT scanning using an iterative reconstruction algorithm does not increase the rate of missed injury diagnoses at the point of care compared with standard-dose WBCT with the benefit of less radiation exposure. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, prospective time-series cohort study recruited 1074 consecutive patients admitted for suspected blunt multiple trauma to an academic metropolitan trauma center in Germany from September 3, 2014, through July 26, 2015, for the standard-dose protocol, and from August 7, 2015, through August 20, 2016, for the low-dose protocol. Five hundred sixty-five patients with suspected blunt multiple trauma prospectively received standard-dose WBCT, followed by 509 patients who underwent low-dose WBCT. Confounding was controlled by segmented regression analysis and a secondary multivariate logistic regression model. Data were analyzed from January 16, 2017, through October 14, 2019. INTERVENTIONS Standard-or low-dose WBCT. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of missed injury diagnoses at the point of care, using a synopsis of clinical, surgical, and radiological findings as an independent reference test. The secondary outcome was radiation exposure with either imaging strategy. RESULTS Of 1074 eligible patients, 971 (mean [SD] age, 52.7 [19.5] years; 649 men [66.8%]) completed the study. A total of 114 patients (11.7%) had multiple trauma, as defined by an Injury Severity Score of 16 or greater. The proportion of patients with any missed injury diagnosis at the point of care was 109 of 468 (23.3%) in the standard-dose and 107 of 503 (21.3%) in the low-dose WBCT groups (risk difference, −2.0% [95% CI, −7.3% to 3.2%]; unadjusted odds ratio, 0.89 [95% CI, 0.66-1.20]; P = .45). Adjustments for autocorrelation and multiple confounding variables did not alter the results. Radiation exposure, measured by the volume computed tomography dose index, was lowered from a median of 11.7 (interquartile range, 11.7-17.6) mGy in the standard-dose WBCT group to 5.9 (interquartile range, 5.9-8.8) mGy in the low-dose WBCT group (P < .001). CONCLUSIONS AND RELEVANCE Low-dose WBCT using iterative image reconstruction does not appear to increase the risk of missed injury diagnoses at the point of care compared with standard-dose protocols while almost halving the exposure to diagnostic radiation.

show abstract

Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients

Cited by 58 publications

References 18 publications

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

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

The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma

Contact Info

Product

Resources

About