Authors: Gerben B Keijzers Don Campbell Jeffrey Hooper Nerolie Bost Julia Crilly Michael Craig Steele Chris Del Mar Leo M G Geeraedts
Publish Date: 2013/10/01
Volume: 38, Issue: 1, Pages: 222-232
Abstract
Prospective beforeandafter cohort study TTS were formalised in a single regional level II trauma hospital in November 2009 All multitrauma patients admitted between March–October 2009 preformalisation of TTS and December 2009–September 2010 post were assessed for missed injury classified into three types Type I inhospital injury missed at initial assessment detected within 24 h Type II inhospital detected in hospital after 24 h missed at initial assessment and by TTS Type III postdischarge detected after hospital discharge Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 monthsA total of 487 trauma patients were included pre n = 235 post n = 252 Inhospital missed injury rate Types I and II combined was similar for both groups 38 vs 48 P = 061 as were postdischarge missed injury rates Type III at 1 month 137 vs 115 P = 043 and 6 months 38 vs 33 P = 084 after discharge TTS performance was substantially higher in the postgroup 27 vs 42 P 0001 Functional outcomes for both cohorts were similar at 1 and 6 months followupThis is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates 15 Some of these injuries were clinically relevant Although TTS performance was significantly improved by formalising the process from 27 to 42 this did not decrease missed injury ratesA common quality indicator in trauma care is missed injury 1 2 Missed injuries are the result of the prioritisation that takes place during the initial assessment and management in the emergency department ED and emergency intervention Because the focus in the ED is on making timecritical decisions complete injury identification during resuscitation including primary and secondary survey is not always feasible 3 4 5Performance of a trauma tertiary survey TTS within 24 h has been suggested as a tool to address this problem and minimise the risk of missed injuries 3 The TTS should follow the episode of emergency care primary and secondary survey and emergency interventions It comprises a comprehensive general physical reexamination and review of all investigations including diagnostic imaging and blood results within 24 h 4 5 6 and again when the patient is conscious cooperative and mobilised 3 6 7
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