Delayed Identification of Skeletal Injury in Multisystem Trauma

Born, Christopher T.; Ross, Steven E.; Iannacone, William M.; Schwab, C. William; DeLong, William G.

doi:10.1097/00005373-198912000-00010

Cited by 84 publications

(26 citation statements)

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“…Reports in the literature reveal that as many as 25% of spinal cord injuries occur in the initial management phases and that up to 50% of mismanaged spinal cord injuries can result in neurologic deterioration. [18][19][20][21][22][23][24][25][26] Maintaining lumbar column integrity is of great importance in the management of the unstable lumbar spine. Any time a patient with an unstable spine is transferred, it is a potential opportunity for injury.…”

Section: Discussionmentioning

confidence: 99%

Motion Generated in the Unstable Lumbar Spine During Hospital bed Transfers

Horodyski

Weight²,

Conrad³

et al. 2009

Journal of Spinal Disorders &Amp; Techniques

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Section: Discussionmentioning

confidence: 99%

Motion Generated in the Unstable Lumbar Spine During Hospital bed Transfers

Horodyski

Weight²,

Conrad³

et al. 2009

Journal of Spinal Disorders &Amp; Techniques

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“…Injuries are more commonly missed in blunt trauma patients as compared to those of penetrating trauma because of the need for simultaneously rapid assessment and resuscitation. 10 Such unrecognized injuries can have a negative impact on patient outcomes. Clinically significant missed injuries, especially abdominal or cervical spine injuries can lead to complications, high morbidity and even death.…”

Section: Discussionmentioning

confidence: 99%

Forensic considerations of missed diagnoses in trauma deaths

Sharma

Gupta

Bangar

et al. 2007

Journal of Forensic and Legal Medicine

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“…When the analysis concentrates on high energy trauma, the incidence exceeds 10%.The most common undiagnosed injuries in the primary and secondary surveys are fractures located on long bones, ribs, and clavicles [150,153]. Less frequent but not less important are fractures of the spine, face, and pelvis [154]; with a much lower reported frequency are intrathoracic and intraabdominal lesions. Visceral and vascular missed wounds are more frequent in series with penetrating trauma mechanisms [146,148,155].…”

Section: Missed Injuries and Tertiary Surveymentioning

confidence: 99%

“…The reasons associated with delayed diagnosis have been investigated, and include trauma severity, conditions that alter the process of attention, conditions that complicate the clinical evaluation, and errors in the process (Box 3) [147,152,154,163,164].…”

Section: Missed Injuries and Tertiary Surveymentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Delayed Identification of Skeletal Injury in Multisystem Trauma

Cited by 84 publications

References 0 publications

Motion Generated in the Unstable Lumbar Spine During Hospital bed Transfers

Motion Generated in the Unstable Lumbar Spine During Hospital bed Transfers

Forensic considerations of missed diagnoses in trauma deaths

Critical Care Issues in the Early Management of Severe Trauma

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