01.12.2010 | Original Article
Predictors of missed injuries in hospitalized trauma patients in the emergency department
M. Emet, A. Saritas, H. Acemoglu, S. Aslan, Z. Cakir
European Journal of Trauma and Emergency Surgery
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To determine the extent of missed injuries in patients hospitalized with major trauma in a Turkish Level 1 emergency department. We also tried to identify the primary factors contributing to each missed injury and to determine their subsequent adverse short-term clinical outcomes.
This is a retrospective analysis of prospectively collected data on a cohort of trauma patients. Trauma patients were divided into two groups: patients with missed injury and others. Logistic regression was used to define factors affecting “missed injury”.
A total of 670 hospitalized trauma patients were included. The incidence of missed injuries in the patients and the rate of missed injury per patient were 13.3% (95% CI 6–20) and 1.64, respectively. The most frequently missed diagnosis was injuries of the musculoskeletal system (38%; 95% CI 30–46). It was “clavicle fracture and/or dislocation” (35%; 95% CI 16–53) when the rate of missed diagnosis according to the frequency of the specific injury was calculated. A multiple logistic regression analysis showed that the predictors of missed injuries were patient’s age (OR 0.74, 95% CI 0.63–0.87), total number of injuries (OR 1.74, 95% CI 1.38–2.20), and ISS (OR 1.10, 95% CI 1.03–1.18). Radiological errors were prominent in almost 90% (95% CI 85–95). Missed injury caused additional hospital stay (30%; 95% CI 21–40) and additional surgery was required (15%; 95% CI 8–23).
The study highlights the need for a trauma team approach and the need for support of radiological report in the ED.