A clinical decision model identifies patients at risk for delayed diagnosed injuries after high-energy trauma

Snoek, Anniek; Dekker, Maaike; Lagrand, Tjerk J; Epema, Anniek; Ploeg, Tjeerd van der; Brand, Johan G. H. van den

doi:10.1097/mej.0b013e328353d926

Cited by 7 publications

(7 citation statements)

References 17 publications

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“…The risk of a missed injury increases when the patient has multiple injuries and/or the patient is unstable (7, 13). Studies have shown that head injuries (4, 6, 13, 14), mechanical ventilation (5, 8), low scores on the Glasgow Coma Scale (GCS) (2, 4, 7, 15), and high Injury Severity Scores (ISS) (2, 4, 7, 15, 16) can lead to delayed diagnosis. Inadequate clinical examinations (9, 11), departures from clinical routines (11), and misinterpreted or inadequate radiographs (2, 4, 5, 8, 11, 17) also contribute to delayed diagnoses.…”

Section: Introductionmentioning

confidence: 99%

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

2016

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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.

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Section: Introductionmentioning

confidence: 99%

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

2016

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“…The mechanism of injury was classified as either highenergy trauma or low-energy trauma. 31 All other data were identified from clinical reports. The neurosurgical procedures were identified from an online register from the neurosurgical hospitals.…”

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confidence: 99%

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Iaccarino¹,

Schiavi²,

Picetti

et al. 2014

JNS

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Object Traumatic parenchymal mass lesions are common sequelae of traumatic brain injuries (TBIs). They occur in up to 8.2% of all TBI cases and 13%–35% of severe TBI cases, and they account for up to 20% of surgical intracranial lesions. Controversy exists concerning the association between radiological and clinical evolution of brain contusions. The aim of this study was to identify predictors of unfavorable outcome, analyze the evolution of brain contusions, and evaluate specific indications for surgery. Methods In a retrospective, multicenter study, patients with brain contusions were identified in separate patient cohorts from 11 hospitals over a 4-year period (2008–2011). Data on clinical parameters and course of the contusion were collected. Radiological parameters were registered by using CT images taken at the time of hospital admission and at subsequent follow-up times. Patients who underwent surgical procedures were identified. Outcomes were evaluated 6 months after trauma by using the Glasgow Outcome Scale-Extended. Results Multivariate analysis revealed the following reliable predictors of unfavorable outcome: 1) increased patient age, 2) lower Glasgow Coma Scale score at first evaluation, 3) clinical deterioration in the first hours after trauma, and 4) onset or increase of midline shift on follow-up CT images. Further multivariate analysis identified the following as statistically significant predictors of clinical deterioration during the first hours after trauma: 1) onset of or increase in midline shift on follow-up CT images (p < 0.001) and 2) increased effacement of basal cisterns on follow-up CT images (p < 0.001). Conclusions In TBI patients with cerebral contusion, the onset of clinical deterioration is predictably associated with the onset or increase of midline shift and worsened status of basal cisterns but not with hematoma or edema volume increase. A combination of clinical deterioration and increased midline shift/basal cistern compression is the most reasonable indicator for surgery.

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“…6. Patients were classified as neurologically deteriorating if the GCS score decreased by at least 2 points or if onset of pupillary abnormalities (as defined by Morris et al 21 ) was registered. The mechanism of injury was classified as either high velocity trauma or low-velocity trauma.…”

Section: Clinical Data Collectionmentioning

confidence: 99%

“…17,20 The term " radiological evolution " has a scientific literature that lacks uniformity in defining it and due to different clinical studies which has reported haemorrhagic contusion progression ( 16.4 % to 51 % ), clinical definition stands controversial. 1,2,4,6,14,15,21,24 .…”

Section: Introduction:-mentioning

confidence: 99%

Haemorrhagic Contusions of Brain : Predictors of Outcome and Relationship Between Clinical and Radiological Evolution.

Balamurugan¹,

KumarJ²,

Indunesh³

2018

IJAR

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A clinical decision model identifies patients at risk for delayed diagnosed injuries after high-energy trauma

Abstract: Our newly developed clinical decision model can identify patients who are at a risk for delayed diagnosed injuries and who should undergo an intensified search for potential unidentified injuries.

Cited by 7 publications

References 17 publications

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

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

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Haemorrhagic Contusions of Brain : Predictors of Outcome and Relationship Between Clinical and Radiological Evolution.

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