Delayed injuries in the emergency department in hospitalised trauma patients

Trauma ◽  
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.

scholarly journals Missed orthopaedic injuries in adult trauma patients at a major trauma centre

2020 ◽  
Author(s):  
Christopher David Roche
Keyword(s):  
Major Trauma ◽  
Whole Body ◽  
Trauma Patients ◽  
Injury Incidence ◽  
Injury Rates ◽  
Missed Injuries ◽  
Missed Injury ◽  
Radiology Reports ◽  
Trauma Networks ◽  
The Impact

IntroductionDespite advances in trauma care, missed injury remains a significant cause of morbidity and mortality in trauma worldwide. In England, few have published their missed injury rates and there are no recent data for London. In 2010 London trauma networks were restructured and the impact on missed injury rates is not known. This study aimed to determine the incidence of missed orthopaedic injury for adult trauma patients at St George’s Hospital, London, and to analyse missed injuries and comment on risk factors.MethodTrauma patients were recorded prospectively at the daily trauma meeting from July to September 2012. The researcher attended clinical activities and reviewed the patient notes and radiology reports daily whilst each patient was an inpatient until discharge. Missed injuries were defined as fractures or dislocations discovered more than 12 h after arrival in the emergency department. The notes for missed injury patients were reviewed again at six months. Missed injury details were recorded/analysed.ResultsThree hundred and forty three adult trauma patients were referred to trauma and orthopaedics in the three-month study period; 5 (1.5%) had a missed injury and 148 (43.1%) had an ISS>15. All missed injuries occurred in these major trauma patients, giving an incidence of 5/148 (3.4%). Four were extremity injuries and one was cervical. All missed injury patients had a GCS of 15/15, were admitted outside normal working hours, were direct admissions and had whole-body CT.ConclusionsAt 3.4% our missed injury incidence is comparable to those published from similar major trauma centres. This provides recent London data following the restructuring of trauma networks.

Normal-range emergency department serum phosphorus levels and all-cause mortality

2020 ◽  
pp. postgradmedj-2019-137159
Author(s):  
Yiftach Barash ◽  
Eyal Klang ◽  
Shelly Soffer ◽  
Eyal Zimlichman ◽  
Avshalom Leibowitz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Final Analysis ◽  
Hospitalisation Rate ◽  
Serum Phosphorus ◽  
Normal Range ◽  
Hospitalised Patients ◽  
All Cause Mortality ◽  
Clinical Consequences ◽  
Phosphorus Levels

Purpose of the studyHypophosphataemia and hyperphosphataemia are frequently encountered in hospitalised patients and are associated with significant clinical consequences. However, the prognostic value of normal-range phosphorus levels on all-cause mortality and hospitalisations is not well established. Therefore, we examined the association between normal-range phosphorus levels, all-cause mortality and hospitalisations in patients presenting to the emergency department of a tertiary medical centre in Israel.Study designA retrospective analysis of patients presenting to the Chaim Sheba Medical Center emergency department between 2012 and 2018. The cohort was divided into quartiles based on emergency department phosphorus levels: ‘very-low-normal’ (p ≥ 2 mg/dL and p ≤ 2.49 mg/dL), ‘low-normal’ (p ≥ 2.5 mg/dL and p ≤ 2.99 mg/dL), ‘high-normal’ (p≥  3 mg/dL and p≤3.49 mg/dL) and ‘very-high-normal’ (p ≥  3.5 mg/dL and p ≤ 4 mg/dL). We analysed the association between emergency department phosphorus levels, hospitalisation rate and 30-day and 90-day all-cause mortality.ResultsOur final analysis included 223 854 patients with normal-range phosphorus levels. Patients with ‘very-low-normal’ phosphorus levels had the highest mortality rate. Compared with patients with ‘high-normal’ phosphorus levels, patients with ‘very-low-normal’ levels had increased 30-day all-cause mortality (OR 1.3, 95% CI 1.1 to 1.4, p<0.001), and increased 90-day all-cause mortality (OR 1.2, 95% CI 1.1 to 1.3, p<0.001). Lower serum phosphorus levels were also associated with a higher hospitalisation rate, both for the internal medicine and general surgery wards (p<0.001).ConclusionsLower phosphorus levels, within the normal range, are associated with higher 30-day and 90-day all-cause mortality and hospitalisation rate.

scholarly journals High delayed and missed injury rate after inter-hospital transfer of severely injured trauma patients

2019 ◽  
Vol 46 (6) ◽  
pp. 1367-1374
Author(s):  
Riquard Lesley Hensgens ◽  
Mostafa El Moumni ◽  
Frank F. A. IJpma ◽  
Jorrit S. Harbers ◽  
Kaj ten Duis ◽  
...  
Keyword(s):  
Injury Rate ◽  
Trauma Patients ◽  
Severely Injured ◽  
Missed Injury ◽  
Hospital Transfer

Prehospital Vital Signs Accurately Predict Initial Emergency Department Vital Signs

2020 ◽  
Vol 35 (3) ◽  
pp. 254-259
Author(s):  
Marc D. Trust ◽  
Morgan Schellenberg ◽  
Subarna Biswas ◽  
Kenji Inaba ◽  
Vincent Cheng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intraclass Correlation ◽  
Vital Signs ◽  
Correlation Coefficients ◽  
Trauma Team ◽  
Urban Setting ◽  
Trauma Patients ◽  
Level I ◽  
Gcs Score ◽  
Good Agreement

AbstractIntroduction:Prehospital vital signs are used to triage trauma patients to mobilize appropriate resources and personnel prior to patient arrival in the emergency department (ED). Due to inherent challenges in obtaining prehospital vital signs, concerns exist regarding their accuracy and ability to predict first ED vitals.Hypothesis/Problem:The objective of this study was to determine the correlation between prehospital and initial ED vitals among patients meeting criteria for highest levels of trauma team activation (TTA). The hypothesis was that in a medical system with short transport times, prehospital and first ED vital signs would correlate well.Methods:Patients meeting criteria for highest levels of TTA at a Level I trauma center (2008-2018) were included. Those with absent or missing prehospital vital signs were excluded. Demographics, injury data, and prehospital and first ED vital signs were abstracted. Prehospital and initial ED vital signs were compared using Bland-Altman intraclass correlation coefficients (ICC) with good agreement as >0.60; fair as 0.40-0.60; and poor as <0.40).Results:After exclusions, 15,320 patients were included. Mean age was 39 years (range 0-105) and 11,622 patients (76%) were male. Mechanism of injury was blunt in 79% (n = 12,041) and mortality was three percent (n = 513). Mean transport time was 21 minutes (range 0-1,439). Prehospital and first ED vital signs demonstrated good agreement for Glasgow Coma Scale (GCS) score (ICC 0.79; 95% CI, 0.77-0.79); fair agreement for heart rate (HR; ICC 0.59; 95% CI, 0.56-0.61) and systolic blood pressure (SBP; ICC 0.48; 95% CI, 0.46-0.49); and poor agreement for pulse pressure (PP; ICC 0.32; 95% CI, 0.30-0.33) and respiratory rate (RR; ICC 0.13; 95% CI, 0.11-0.15).Conclusion:Despite challenges in prehospital assessments, field GCS, SBP, and HR correlate well with first ED vital signs. The data show that these prehospital measurements accurately predict initial ED vitals in an urban setting with short transport times. The generalizability of these data to settings with longer transport times is unknown.

scholarly journals A comparative study of designated trauma team leaders on trauma patient survival and emergency department length-of-stay

CJEM ◽  
2007 ◽  
Vol 9 (02) ◽  
pp. 105-110 ◽  
Author(s):  
Garnet E. Cummings ◽  
Damon C. Mayes
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Injury Severity ◽  
Patient Survival ◽  
Negative Impact ◽  
Trauma Team ◽  
Regression Modeling ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Trauma Severity

ABSTRACT Objectives: There is controversy over who should serve as the Trauma Team Leader (TTL) at trauma-receiving centres. This study compared survival and emergency department (ED) length-of-stay between patients cared for by 3 different groups of TTLs: surgeons, emergency physicians (EPs) on call for trauma cases and EPs on shift in the ED. Methods: We performed a retrospective cohort study involving all adult major blunt trauma patients (aged 17 and older) who were admitted to 2 level I trauma centres and who were entered into a provincial Trauma Registry between March 2000 and April 2002. The study was designed to compare the effect of TTL-type on survival and ED length-of-stay, while controlling for sex, age, and trauma severity as defined by the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). Analysis was performed using linear regression modeling (for the ED lenght-of-stay outcome variable), and logistic regression modeling (for the surivial outcome variable). Results: There were 1412 patients enrolled in the study. The study population comprised 74% men and 26% women, with a mean age of 44.7 years (43.1, 46.6 and 42.8 years for surgeons, on-call EPs and on-shift EPs, respectively). The overall mean ISS was 23.2 (23.7 for surgeons, 22.9 for on-call EPs and 23.3 for on-shift EPs) and the overall average RTS was 7.6 (7.6 for surgeons, 7.6 for on-call EPs and 7.5 for on-shift EPs). The overall median ED length-of-stay was 5.3 hours (4.5, 5.3 and 5.6 hours for surgeons, on-call EPs and on-shift EPs, respectively; p = 0.07) and the overall survival was 87% (86% surgeon, 88% on-call EP, 87% on-shift EP; p = 0.08). No statistically significant relationship was found between TTL-type and ED length-of-stay (p = 0.42) or survival (p = 0.43) using multivariate modeling. Conclusion: Our results suggest that surgeons, on-call EPs, or on-shift EPs can act as the TTL without a negative impact on patient survival or ED length-of-stay.

Meta-analysis of the effect of tertiary survey on missed injury rate in trauma patients

Injury ◽  
2015 ◽  
Vol 46 (12) ◽  
pp. 2474-2482 ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Nosakhare Idehen
Keyword(s):  
Meta Analysis ◽  
Injury Rate ◽  
Trauma Patients ◽  
Missed Injury ◽  
Tertiary Survey

Computed Tomography versus Magnetic Resonance Imaging for Evaluation of the Cervical Spine: How Many Slices do you Need?

2010 ◽  
Vol 76 (4) ◽  
pp. 365-368 ◽  
Author(s):  
Carlos V.R. Brown ◽  
Kelli H. Foulkrod ◽  
Andrew Reifsnyder ◽  
Eric Bui ◽  
Irene Lopez ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Injury Rate ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Missed Injury ◽  
Spine Injuries ◽  
Ct Scanners ◽  
Clinically Significant ◽  
Ct And Mri

Controversy exists regarding the correlation between CT and MRI for evaluation of the cervical spine. We hypothesize that newer-generation CT scanners will improve diagnostic accuracy and may obviate the need for MRI in patients with a normal CT. We compared the missed injury rate of four-slice CT and 64-slice CT performed to evaluate the cervical spine. We conducted a retrospective study from January 2004 to June 2008 of all blunt trauma patients who underwent both a CT and MRI to evaluate the cervical spine. One hundred six blunt trauma patients underwent both CT and MRI, including 43 with four-slice and 63 with 64-slice CT. CT missed three injuries (3%), all of which were clinically significant ligamentous injuries seen only on MRI. The 64-slice CT missed no injuries (0%), whereas the four-slice CT missed all three (7%) of the ligamentous injuries ( P = 0.03). Older-generation CT scanners miss clinically significant injuries in blunt trauma patients and should not be independently relied on to evaluate the cervical spine. The newer 64-slice CT scan does not appear to miss clinically significant cervical spine injuries and may allow clearance of the cervical spine in blunt trauma patients without the addition of an MRI.

Reduction of Radiation Dose in Pediatric Brain CT is not Associated with Missed Injuries or Delayed Diagnosis

2010 ◽  
Vol 76 (11) ◽  
pp. 1255-1259
Author(s):  
Rodrigo Arrangoiz ◽  
Razvan C. Opreanu ◽  
Benjamin D. Mosher ◽  
Chet A. Morrison ◽  
Penny Stevens ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Injury Rate ◽  
Conventional Radiography ◽  
Trauma Patients ◽  
Traumatic Injuries ◽  
Brain Ct ◽  
Missed Injury ◽  
Incidence And Mortality ◽  
Tube Current ◽  
Dose Saving

Increased accuracy of CTs in the identification of traumatic injuries compared with physical examination or conventional radiography is well documented. Our goal was to identify the most effective strategy for decreasing radiation exposure while retaining the benefits of computerized imaging. Based on a literature review and our trauma registry, the mortality risk of untreated injuries was compared with that of patients who received treatment of injuries diagnosed by CT. Because automated exposure control of tube current is not routinely used with brain CT, this region was identified as the initial focus for a dose-saving algorithm. CT settings were adjusted for children studies and the new settings were implemented into four protocols based on age. Images were compared and reviewed by radiologists for the ability to identify traumatic injuries. Effective dose (ED) was estimated using Monte Carlo simulations. The lifetime incidence and mortality for thyroid cancer and leukemia were assessed. In-hospital mortality of unidentified injury in trauma patients is 8.0%. Forty dose-saving CTs were performed and no injuries were missed. The ED decreased by 5.2-, 4.5-, 2.62-, and 2.5-fold in each group. Decreasing the ED is achievable, theoretically decreases the cancer risk and does not increase the missed injury rate.

Predictors of missed injuries in hospitalized trauma patients in the emergency department

2010 ◽  
Vol 36 (6) ◽  
pp. 559-566 ◽  
Author(s):  
M. Emet ◽  
A. Saritas ◽  
H. Acemoglu ◽  
S. Aslan ◽  
Z. Cakir
Keyword(s):  
Emergency Department ◽  
Trauma Patients ◽  
Missed Injuries

scholarly journals Missed Injuries in Polytrauma Patients after Trauma Tertiary Survey in Trauma Intensive Care Unit

2016 ◽  
Vol 105 (4) ◽  
pp. 241-247 ◽  
Author(s):  
E. Tammelin ◽  
L. Handolin ◽  
T. Söderlund
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Injury Rate ◽  
Trauma Patients ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Missed Injuries ◽  
Tertiary Survey ◽  
Survey Protocol

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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