Delayed diagnosed trauma in severely injured patients despite guidelines-oriented emergency room treatment: there is still a risk

Purpose Emergency trauma room treatment follows established algorithms such as ATLS®. Nevertheless, there are injuries that are not immediately recognized here. The aim of this study was to evaluate the residual risk for manifesting life-threatening injuries despite strict adherence to trauma room guidelines, which is different to missed injuries that describe recognizable injuries. Methods In a retrospective study, we included 2694 consecutive patients admitted to the emergency trauma room of one single level I trauma center between 2016 and 2019. In accordance with the trauma room algorithm, primary and secondary survey, trauma whole-body CT scan, eFAST, and tertiary survey were performed. Patients who needed emergency surgery during their hospital stay for additional injury found after guidelines-oriented emergency trauma room treatment were analyzed. Results In seven patients (0.26%; mean age 50.4 years, range 18–90; mean ISS 39.7, range 34–50), a life-threatening injury occurred in the further course: one epidural bleeding (13 h after tertiary survey) and six abdominal hollow organ injuries (range 5.5 h–4 days after tertiary survey). Two patients (0.07% overall) with abdominal injury died. The “number needed to fail” was 385 (95%–CI 0.0010–0.0053). Conclusion Our study reveals a remaining risk for delayed diagnosis of potentially lethal injuries despite accurate emergency trauma room algorithms. In other words, there were missed injuries that could have been identified using this algorithm but were missed due to other reasons. Continuous clinical and instrument-based examinations should, therefore, not be neglected after completion of the tertiary survey. Level of evidence Level II: Development of diagnostic criteria on the basis of consecutive patients (with universally applied reference “gold” standard).

Workplace violence towards resident doctors in Indian teaching hospitals: A quantitative survey

Violence at work is becoming an alarming phenomenon worldwide affecting the millions of health care workers. This study was conducted to assess the violence towards Resident doctors in Indian teaching hospitals. Google forms questionnaire was developed and circulated electronically to resident doctors working in India. Data were collected and managed using the Google forms electronic tool. Vast majority (86%) of respondents reported having experienced violence with no difference among two genders. Prevalence of violence was maximum (35.5%) in general surgery. Verbal threat and abuse was the commonest (∼94%) form of violence. Mostly these acts of violence happened in Emergency/Trauma room. The most common reasons for violence in hospital were patient's death. Over 94% residents accepted that they had never received any training to deal with work place violence. Majority (80%) of the respondents favoured better communication, strict Laws and strengthening of security measures in hospital to prevent WPV. Workplace violence prevention should be addressed aggressively and comprehensively in health care. A workplace violence prevention program should be a required component of all health care organizations.