Missed injury in major trauma patients

Brooks, Adam; Holroyd, B; Riley, Bernard

doi:10.1016/s0020-1383(03)00219-5

Cited by 120 publications

(84 citation statements)

References 10 publications

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“…Delayed diagnosis of lesions has been reported to occur between 0.5% to 38%, in different trauma populations [146][147][148][149][150][151][152]. 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].…”

Section: Missed Injuries and Tertiary Surveymentioning

confidence: 99%

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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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Section: Missed Injuries and Tertiary Surveymentioning

confidence: 99%

“…To limit the number and the impact of the lesions diagnosed lately, a "tertiary survey" has been proposed [147,151,165]. It consists of a systematic re-view of the patient at the completion of the first day.…”

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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“…Some publications focused on those missed injuries that were associated with high morbidity and mortality because of delayed diagnosis [70,72]. Others used the requirement of further surgical procedures as criteria to define clinically significant missed injuries [68]. In our study many fractures were missed clinically or were diagnosed as other fractures because of local condition, unusual presentation.…”

Section: Discussionmentioning

confidence: 79%

Meta Analysis of Etiology and its Clinical and Radiological Correlation in Cases of Craniomaxillofacial Trauma

Kumar¹,

Ahmed²,

Hashmi³

et al. 2016

J. Maxillofac. Oral Surg.

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Aim The present study was planned to investigate the etiology of injuries and to analyze correlation between clinical and radiological findings in cases of craniomaxillofacial trauma. Study Design An 18 months cross-sectional study was done and 325 patients with maxillofacial fractures were analyzed from January 2013 to June 2014 who reported to the department of oral and maxillofacial surgery, Aligarh, Uttar Pradesh. Data was recorded in a preformed case sheet which included: patient's demographic data, cause of injury, type of injury, treatment plan. Results Out of the 325 patients, 74.4 % were males with a male: female ratio of 2.91:1. The 21-30 year age group was found to be maximum. Road traffic accidents accounted for 71.3 %, followed by fall from height (19 %) and assault (9.5 %). Most commonly involved vehicles were two wheelers followed by public transport. Mandibular fractures (65 %) were most prevalent, followed by zygomaticomaxillary complex (44.27 %), parietal bone (48 %) and orbital fractures (21.3 %). Thirtyseven fractures (7.14 %) were missed clinically which were confirmed later by radiographic technique. Maximum were in cranium region (57 %) followed by mandible (27 %), mid face region (16.21 %). Thirty-three fractures (6.37 %) were overestimated or suspected clinically which could not be confirmed by radiographic technique. Maximum were in mandible (48.5 %) followed by mid face (36.33 %) and cranium (15.15 %). Conclusion The idea behind this article is to analyze the various trends and affecting factors and correlation between clinical and radiological findings. A better understanding of the above said would help in future treatment planning and management of facial injuries.

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“…8 The management of such injuries involves initial fluid resuscitation followed by laparoscopic or open debridement of the wound with primary closure or a partial gastrectomy. 10 …”

Section: Discussionmentioning

confidence: 99%

Missed Gastric Injuries in Blunt Abdominal Trauma: Case report with review of literature

Naiem

Taqi

Al-Kendi

et al. 2016

SQUMJ

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Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate.

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Missed injury in major trauma patients

Cited by 120 publications

References 10 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Meta Analysis of Etiology and its Clinical and Radiological Correlation in Cases of Craniomaxillofacial Trauma

Missed Gastric Injuries in Blunt Abdominal Trauma: Case report with review of literature

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