Tertiary Survey Performance in a Regional Trauma Hospital Without a Dedicated Trauma Service

Abstract

Background Initial management of trauma patients is focused on identifying life-and limb-threatening injuries and may lead to missed injuries. A tertiary survey can minimise the number and effect of missed injuries and involves a physical re-examination and review of all investigations within 24 h of admission. There is little information on current practice of tertiary survey performance in hospitals without a dedicated trauma service. We aimed to determine the rate of tertiary survey performance and the detail of documentation as well as the baseline rate of missed injuries. Methods We performed a retrospective, descriptive study of all multitrauma patients who presented to an Australian level II regional trauma centre without a dedicated trauma service between May 2008 and February 2009. A medical records review was conducted to determine tertiary survey performance and missed injury rate. Results Of 252 included trauma patients, 20% (n = 51) had a tertiary survey performed. A total of nine missed injuries were detected in eight patients (3.2%). Of the multiple components of the tertiary survey, most were poorly documented. Documentation was more comprehensive in the subgroup of patients who did have a formal tertiary survey.

What is the effect of a formalised trauma tertiary survey procedure on missed injury rates in multi-trauma patients? Study protocol for a randomised controlled trial

“…All multi-trauma patients admitted to hospital for at least 24 hours will be prospectively identified using and Emergency Department Information System (EDIS or equivalent) and are eligible for recruitment if they meet the inclusion criteria based on previous work [ 15 , 16 ].…”

“…Inclusion criteria as used in previous studies [ 15 , 16 ] are as follows: 16 years and older Admitted for at least 24 hours (since TTS can be performed up to 24 hrs) and any of the following: Injuries in two or more body regions High impact mechanism (high speed motor vehicle collision, pedestrian versus car, fall from >1.5 meter) Chest or abdominal injuries Fractured neck of femur under the age of 65 years. …”

“…The primary intervention will be at the hospital level and outcomes will be measured at the patient level. The intervention will consist of the following: The implementation of a formalised TTS form (Additional file 1 : Appendix A) , used in two previous studies [ 15 , 16 ]). This form prompts documentation for relevant features of history (such as mechanism of injury) and physical examination of relevant body regions.…”

“…The implementation of a formalised TTS form (Additional file 1 : Appendix A) , used in two previous studies [ 15 , 16 ]). This form prompts documentation for relevant features of history (such as mechanism of injury) and physical examination of relevant body regions.…”

“…A retrospective study [ 15 ] in our Australian level II trauma facility found poor compliance to routine TTS and identified a lack of data regarding post-discharge missed injuries. A subsequent, pragmatic, prospective before-and-after study [ 16 ] evaluated the implementation of a formalised TTS procedure by measuring missed injury rates during a hospital stay (Type I and II) as well as after discharge (Type III).…”