A Prospective Evaluation of Missed Injuries in Trauma Patients, Before and After Formalising the Trauma Tertiary Survey

Background and Aims: Injuries are often missed during the primary and secondary surveys in trauma patients. Studies have suggested that a formal tertiary survey protocol lowers the number of missed injuries. Our aim was to determine the number, severity, and consequences of injuries missed by a non-formalized trauma tertiary survey, but detected within 3 months from the date of injury in trauma patients admitted to a trauma intensive care unit. Material and Methods: We conducted a cohort study of trauma patients admitted to a trauma intensive care unit between 1 January and 17 October 2013. We reviewed the electronic medical records of patients admitted to the trauma intensive care unit in order to register any missed injuries, their delay, and possible consequences. We classified injuries into four types: Type 0, injury detected prior to trauma tertiary survey; Type I, injury detected by trauma tertiary survey; Type II, injury missed by trauma tertiary survey but detected prior to discharge; and Type III, injury missed by trauma tertiary survey and detected after discharge. Results: During the study period, we identified a total of 841 injuries in 115 patients. Of these injuries, 93% were Type 0 injuries, 3.9% were Type I injuries, 2.6% were Type II injuries, and 0,1% were Type III injuries. Although most of the missed injuries in trauma tertiary survey (Type II) were fractures (50%), only 2 of the 22 Type II injuries required surgical intervention. Type II injuries presumably did not cause extended length of stay in the intensive care unit or in hospital and/or morbidity. Conclusion: In conclusion, the missed injury rate in trauma patients admitted to trauma intensive care unit after trauma tertiary survey was very low in our system without formal trauma tertiary survey protocol. These missed injuries did not lead to prolonged hospital or trauma intensive care unit stay and did not contribute to mortality. Most of the missed injuries received non-surgical treatment.

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Prospective Evaluation of Residents On Call: Before and After Duty-Hour Reduction

Yearbook of Pediatrics ◽

10.1016/j.yped.2012.03.027 ◽

2013 ◽

Vol 2013 ◽

pp. 345-347

Author(s):

J.A. Stockman

Keyword(s):

Prospective Evaluation ◽

Before And After

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Prehospital triage of trauma patients before and after implementation of a regional triage guideline

Injury ◽

10.1016/j.injury.2021.10.011 ◽

2021 ◽

Author(s):

Joachim Hansen ◽

Lars Simon Rasmussen ◽

Jacob Steinmetz

Keyword(s):

Trauma Patients ◽

Before And After ◽

Prehospital Triage

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Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

10.21203/rs.3.rs-147008/v1 ◽

2021 ◽

Author(s):

Adel Hamed Elbaih ◽

Maged El-Setouhy ◽

Jon Mark Hirshon ◽

Hazem Mohamed El-Hariri ◽

Mohamed El-Shinawi

Keyword(s):

Low Income ◽

Life Support ◽

University Hospital ◽

Low Income Countries ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Education Programs ◽

Missed Injuries ◽

Polytrauma Patients ◽

Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

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Postablation Assessment Using Follow-Up Registration of CT Images Before and After Radiofrequency Ablation (RFA): Prospective Evaluation of Midterm Therapeutic Results of RFA for Hepatocellular Carcinoma

American Journal of Roentgenology ◽

10.2214/ajr.13.11709 ◽

2014 ◽

Vol 203 (1) ◽

pp. 70-77 ◽

Cited By ~ 13

Author(s):

Sooyoung Shin ◽

Jeong Min Lee ◽

Kyung Won Kim ◽

Ijin Joo ◽

Joon Koo Han ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Ct Images ◽

Prospective Evaluation ◽

Therapeutic Results ◽

Before And After

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Tertiary survey in trauma patients: avoiding neglected injuries

Injury ◽

10.1016/s0020-1383(14)70014-2 ◽

2014 ◽

Vol 45 ◽

pp. S14-S17 ◽

Cited By ~ 11

Author(s):

Caio Zamboni ◽

Alexandre Maris Yonamine ◽

Carlos Eduardo Nunes Faria ◽

Marco Antonio Machado Filho ◽

Ralph Walter Christian ◽

...

Keyword(s):

Trauma Patients ◽

Tertiary Survey

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Missed Injuries in Trauma Patients

JBJS Orthopaedic Highlights Trauma ◽

10.2106/jbjs.ot.l.00306 ◽

2012 ◽

Vol 2 (9) ◽

pp. e2 ◽

Cited By ~ 1

Author(s):

P.V. Giannoudis

Keyword(s):

Trauma Patients ◽

Missed Injuries

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Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti

BMC Emergency Medicine ◽

10.1186/s12873-019-0266-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Alessandro Jachetti ◽

Rose Berly Massénat ◽

Nathalie Edema ◽

Sophia C. Woolley ◽

Guido Benedetti ◽

...

Keyword(s):

Tranexamic Acid ◽

Traumatic Event ◽

Penetrating Trauma ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Early Administration ◽

Massive Haemorrhage ◽

Low Resource ◽

Resource Setting ◽

Before And After

Abstract Background Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA. Methods Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit. Results One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02). Conclusions Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.

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Delayed injuries in the emergency department in hospitalised trauma patients

Trauma ◽

10.1177/1460408619837845 ◽

2019 ◽

Vol 22 (1) ◽

pp. 64-69

Author(s):

Serhat Orun ◽

Ayhan Akoz ◽

Ali Duman ◽

Kenan Ahmet Turkdogan ◽

Mevlüt Türe ◽

...

Keyword(s):

Emergency Department ◽

Injury Rate ◽

Trauma Team ◽

Trauma Patients ◽

Missed Injuries ◽

Missed Injury ◽

Radiology Reports ◽

Hospitalised Patients ◽

Clinical Consequences ◽

Emergency Service Workers

Introduction Busy emergency departments are associated with medical errors in care and evaluation for unstable trauma patients. Our study aimed to determine the extent, causes and adverse clinical consequences of missed injuries and delayed diagnoses in patients hospitalised with trauma in a Turkish Level 3 emergency department, and provide recommendations for emergency service workers and supervisors to help them reduce the number of injury diagnoses that are delayed. Methods In our prospective study, a total of 515 emergency department patients presenting with trauma between 1 July 2014 and 1 July 2015 were examined by an emergency physician and by a consultant, if necessary. Identified injuries were recorded using case forms, and hospitalised patients were discharged when their treatment was completed. After the patients were discharged their files were reviewed again and new injuries, different from those recorded in the case forms, were investigated. Results Of the 515 patients included, it was shown that an injury diagnosis had been delayed in 21 (3.9%). Of these injuries, 65% were related to the musculoskeletal system. Insufficient clinical evaluation of 95% of the patients who had a missed injury was identified, and, in 70% of missed injuries, the radiology reports had been delayed or incorrectly completed. Conclusion We believe that the delayed injury rate can be reduced in trauma patients with the use of fast and reliable radiological support and the intervention of a multidisciplinary trauma team.

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