Prospective evaluation of early missed injuries and the role of tertiary trauma survey.

BACKGROUND This study prospectively evaluated the prevalence, clinical significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant missed injury, tertiary survey, and contributing factors were defined. Tertiary survey was conducted within 24 hours. RESULTS Of 206 patients, 134 patients (65%) had 309 missed injuries composing 39% of all 798 injuries seen. Tertiary trauma survey detected 56% of early missed injuries and 90% of clinically significant missed injuries within 24 hours. Clinically significant missed injuries occurred in 30 patients with complications in 11 patients and death in two patients. Of 224 contributing errors, 123 errors were in clinical assessment, 83 errors were in radiology, 14 errors were patient related, and four errors were technical. The missed injury rate was significantly higher in patients with multiple injuries and in those involved in road crashes. CONCLUSIONS Secondary trauma survey is not a definitive assessment and should be supplemented by tertiary trauma survey.

[1]  Kon-Hong Kim,et al.  Missed injuries in abdominal trauma. , 1996, The Journal of trauma.

[2]  K. Hillman,et al.  Trauma outcomes: A death analysis study , 1996, Irish journal of medical science.

[3]  G. Sagar,et al.  Whiplash injury associated with acute bilateral internal carotid arterial dissection. , 1996, The Journal of trauma.

[4]  M. Sugrue,et al.  A modified combination technique for performing diagnostic peritoneal lavage. , 1995, The Australian and New Zealand journal of surgery.

[5]  D. Sloane,et al.  A prospective study of the performance of the trauma team leader. , 1995, The Journal of trauma.

[6]  B. Boulanger,et al.  Injuries missed during initial assessment of blunt trauma patients. , 1994, Accident; analysis and prevention.

[7]  M. Harris,et al.  Undiagnosed fractures in severely injured children and young adults. Identification with technetium imaging. , 1994, The Journal of bone and joint surgery. American volume.

[8]  M. K. Allen,et al.  Causes and patterns of missed injuries in trauma. , 1994, American journal of surgery.

[9]  P. A. Frawley.  Missed injuries in the multiply traumatized. , 1993, The Australian and New Zealand journal of surgery.

[10]  A. Hirshberg,et al.  Reoperation for bleeding in trauma. , 1993, Archives of surgery.

[11]  James W. Davis,et al.  The etiology of missed cervical spine injuries. , 1993, The Journal of trauma.

[12]  S. Thomson,et al.  Undetected injuries: a preventable cause of increased morbidity and mortality. , 1991, American journal of surgery.

[13]  B. Enderson,et al.  Missed Injuries: The Trauma Surgeon’s Nemesis , 1991 .

[14]  B. Walters,et al.  Improving the record of patient assessment in the trauma room. , 1990, The Journal of trauma.

[15]  M Juhl,et al.  Missed injuries in an orthopaedic department. , 1990, Injury.

[16]  B. Enderson,et al.  The tertiary trauma survey: a prospective study of missed injury. , 1989, The Journal of trauma.

[17]  S. Ross,et al.  Delayed identification of skeletal injury in multisystem trauma: the 'missed' fracture. , 1989, The Journal of trauma.

[18]  J. L. Thomsen,et al.  Detection of injuries in traumatic deaths. The significance of medico-legal autopsy. , 1989, Forensic science international.

[19]  A. Hirshberg,et al.  Pitfalls in the management of penetrating chest trauma. , 1989, American journal of surgery.

[20]  C Read,et al.  The management of injuries--a review of deaths in hospital. , 1988, The Australian and New Zealand journal of surgery.

[21]  T. Scalea,et al.  Injuries missed at operation: nemesis of the trauma surgeon. , 1987, The Journal of trauma.

[22]  T. Hamdan.  Missed injuries in casualties from the Iraqi-Iranian war: a study of 35 cases. , 1987, Injury.

[23]  J. Sikorski,et al.  Diagnostic failures in the multiple injured. , 1980, The Journal of trauma.