Reducing Missed Injuries at a Level II Trauma Center

Howard, Janet; Sundararajan, R; Thomas, Scott; Walsh, Mark; Sundararajan, Miel

doi:10.1097/00043860-200607000-00003

Cited by 25 publications

(30 citation statements)

References 11 publications

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“…We discarded 4,615 after examining their Title or Abstract. The full-text articles of the remaining 44 were retrieved: 10 studies [3,11-13,21-25] were included in the review, (of which three were suitable for meta-analysis, Figure 1; Table 1). None were randomized or quasi-randomized trials, that is, all 10 included studies were observational, (seven prospective cohort studies [8,12,13,22-25]; one prospective cohort study with historical comparison [1]; and two cohort studies with a before-and-after design [11,21]).…”

Section: Resultsmentioning

confidence: 99%

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The effect of tertiary surveys on missed injuries in trauma: a systematic review

Keijzers

Giannakópoulos

Mar

et al. 2012

Scand J Trauma Resusc Emerg Med

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BackgroundTrauma tertiary surveys (TTS) are advocated to reduce the rate of missed injuries in hospitalized trauma patients. Moreover, the missed injury rate can be a quality indicator of trauma care performance. Current variation of the definition of missed injury restricts interpretation of the effect of the TTS and limits the use of missed injury for benchmarking. Only a few studies have specifically assessed the effect of the TTS on missed injury. We aimed to systematically appraise these studies using outcomes of two common definitions of missed injury rates and long-term health outcomes.MethodsA systematic review was performed. An electronic search (without language or publication restrictions) of the Cochrane Library, Medline and Ovid was used to identify studies assessing TTS with short-term measures of missed injuries and long-term health outcomes. ‘Missed injury’ was defined as either: Type I) any injury missed at primary and secondary survey and detected by the TTS; or Type II) any injury missed at primary and secondary survey and missed by the TTS, detected during hospital stay. Two authors independently selected studies. Risk of bias for observational studies was assessed using the Newcastle-Ottawa scale.ResultsTen observational studies met our inclusion criteria. None was randomized and none reported long-term health outcomes. Their risk of bias varied considerably. Nine studies assessed Type I missed injury and found an overall rate of 4.3%. A single study reported Type II missed injury with a rate of 1.5%. Three studies reported outcome data on missed injuries for both control and intervention cohorts, with two reporting an increase in Type I missed injuries (3% vs. 7%, P<0.01), and one a decrease in Type II missed injuries (2.4% vs. 1.5%, P=0.01).ConclusionsOverall Type I and Type II missed injury rates were 4.3% and 1.5%. Routine TTS performance increased Type I and reduced Type II missed injuries. However, evidence is sub-optimal: few observational studies, non-uniform outcome definitions and moderate risk of bias. Future studies should address these issues to allow for the use of missed injury rate as a quality indicator for trauma care performance and benchmarking.

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Section: Resultsmentioning

confidence: 99%

“…Seven studies did not have a comparison cohort (i.e. a cohort without TTS performed), increasing their risk of bias [8,12,13,22-25]. There was insufficient information to assess the comparability section of the Newcastle-Ottawa scale for eight studies.…”

Section: Resultsmentioning

confidence: 99%

The effect of tertiary surveys on missed injuries in trauma: a systematic review

Keijzers

Giannakópoulos

Mar

et al. 2012

Scand J Trauma Resusc Emerg Med

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“…In both studies, the goal of the intervention was to avoid delayed or missed diagnosis of traumatic injuries through changes in care processes. Perno et al 15 described the implementation of a paediatric trauma response team, whereas Howard et al 16 implemented a comprehensive re-evaluation of trauma patients within 24 h of admission. Both interventions produced positive results: implementing the paediatric response team significantly reduced delayed diagnosis of injury, 15 and Report discrepancies in radiology reports to emergency department Anon 28 Establish back-up processes so that any information about test results can be easily retrieved again Anon 29 Establish highly structured hand-offs that are performed systematically Anon 29 Systematic tracking of diagnostic error in organisation Colgan 30 tertiary examination of trauma patients identified significantly more previously missed injuries.…”

Section: Resultsmentioning

confidence: 99%

“…Both interventions produced positive results: implementing the paediatric response team significantly reduced delayed diagnosis of injury, 15 and Report discrepancies in radiology reports to emergency department Anon 28 Establish back-up processes so that any information about test results can be easily retrieved again Anon 29 Establish highly structured hand-offs that are performed systematically Anon 29 Systematic tracking of diagnostic error in organisation Colgan 30 tertiary examination of trauma patients identified significantly more previously missed injuries. 16 …”

Section: Resultsmentioning

confidence: 99%

System-related interventions to reduce diagnostic errors: a narrative review

et al. 2011

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Background Diagnostic errors (missed, delayed, or wrong diagnosis) have gained recent attention and are associated with significant preventable morbidity and mortality. We reviewed the recent literature to identify interventions that have been, or could be, implemented to address systems-related factors that contribute directly to diagnostic error. Methods We conducted a comprehensive search using multiple search strategies. We first identified candidate articles in English between 2000 and 2009 from a PubMed search that exclusively evaluated for articles related to diagnostic error or delay. We then sought additional papers from references in the initial dataset, searches of additional databases, and subject matter experts. Articles were included if they formally evaluated an intervention to prevent or reduce diagnostic error; however, we also included papers if interventions were suggested and not tested in order to inform the state-of-the science on the topic. We categorized interventions according to the step in the diagnostic process they targeted: patient-provider encounter, performance and interpretation of diagnostic tests, follow-up and tracking of diagnostic information, subspecialty and referral-related; and patient-specific. Results We identified 43 articles for full review, of which 6 reported tested interventions and 37 contained suggestions for possible interventions. Empirical studies, though somewhat positive, were non-experimental or quasi-experimental and included a small number of clinicians or health care sites. Outcome measures in general were underdeveloped and varied markedly between studies, depending on the setting or step in the diagnostic process involved. Conclusions Despite a number of suggested interventions in the literature, few empirical studies have tested interventions to reduce diagnostic error in the last decade. Advancing the science of diagnostic error prevention will require more robust study designs and rigorous definitions of diagnostic processes and outcomes to measure intervention effects.

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“…Although no consensus definition exists, 35 a missed injury has been described as an injury identified after the primary or secondary survey, or more than 24 hours after admission. 36 In this study, we use the term ''delayed,'' rather than ''missed,'' as all patients had an eventual diagnosis of a hand injury.…”

Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of Hand Injuries in Polytrauma Patients

Adkinson

Shafqat

Eid

et al. 2012

Annals of Plastic Surgery

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Trauma patients are at high risk for delayed diagnosis of injuries, including those to the hand, with reports in the literature as high as 50%. As a result, patients may have prolonged disability and longer hospital stays with associated increased costs. Our objective was to elucidate risk factors for the delayed diagnosis of hand injuries. A review was performed from 2000 through 2009, assessing for age, sex, blood alcohol level, Glasgow Coma Score (GCS), Injury Severity Score (ISS), mechanism, injury type, length of stay, and timing of hand injury diagnosis. In this study, 36,568 patients were identified; 738 meeting criteria; 21.7% of patients had delayed diagnoses with 91.3% of patients diagnosed by the day after admission. Delayed diagnoses were more than 2 times higher for severely injured patients. Patients with delayed diagnoses had a lower GCS and a higher ISS and length of hospitalization. With a decreased GCS and elevated ISS, patients are at risk for delayed diagnoses of hand injuries. A focused tertiary survey is mandatory, particularly in patients with an altered mental status or with multiple injuries.

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Reducing Missed Injuries at a Level II Trauma Center

Cited by 25 publications

References 11 publications

The effect of tertiary surveys on missed injuries in trauma: a systematic review

The effect of tertiary surveys on missed injuries in trauma: a systematic review

System-related interventions to reduce diagnostic errors: a narrative review

Delayed Diagnosis of Hand Injuries in Polytrauma Patients

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