Missed injuries in patients with multiple trauma

Objective—To determine the incidence, contributing factors and clinical outcomes of missed injuries among multiply injured patients treated at a Canadian Level I trauma centre.

Method—This retrospective study reviewed the hospital notes of injured patients who were admitted to hospital over a 27 month period, with particular reference to “missed injuries”. The definition of a “missed injury” was one that was not diagnosed during the first 24 hours of admission—as a result, patients who were discharged directly from the emergency department, or who died within 24 hours of hospital presentation were excluded. The characteristics of patients with missed injuries were examined and compared with those without missed injuries using χ² and Student's t tests.

Results—Of 567 patients who were admitted to hospital and who survived for more than 24 hours, 46 (8.1%) had a total of 63 injuries that were “missed”. Thirty one (49%) of the missed injuries were fractures. The mean delay in diagnosis was 14.6 days. The missed injury population contained a significantly higher proportion of patients with GCS ⩽8 and had “significantly higher mean injury severity scores”. Of the 46 patients with missed injuries, in seven the delay was judged to be clinically significant, including one where the delay in diagnosis was judged to have resulted in death. Inadequate clinical assessment was implicated as the most common reason for injuries to be missed.

Conclusions—The authors concluded that patients with missed injuries tended to be more severely injured and neurologically compromised. Assessment of how injuries were missed suggested that while some of the factors involved were “unavoidable”, many were potentially avoidable given repeat clinical assessments and a high index of suspicion.

Critique—The issue of missed injuries in the multiply injured is certainly an …