Ten-Year Retrospective Study of Delayed Diagnosis of Injury in Pediatric Trauma Patients at a Level II Trauma Center

Williams, Benjamin G.; Hlaing, Thein; Aaland, Mary Oline

doi:10.1097/pec.0b013e3181b0a07d

Cited by 18 publications

(12 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients at risk were those with increased ISS, LOS, requirement for ICU care, and intubation, which is similar to other pediatric trauma studies. [9–11] However, similar to our readmissions, only ISS was associated with increased risk of missed injury on multivariate analysis in our series.…”

Section: Discussionsupporting

confidence: 83%

Missed injuries and unplanned readmissions in pediatric trauma patients

Choi

Keller

2017

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Background We sought to determine the incidence and characteristics of missed injuries and unplanned readmissions at a Level-1 pediatric trauma center. Methods We conducted a retrospective review of all trauma patients who presented to our ACS-Verified Level-1 pediatric trauma center from 2009–2014. Results Overall, there were 27 readmissions and 27 missed injuries (0.38%). Patients who were unplanned readmissions had a greater Injury Severity Score (ISS) (8.6 vs 5.2, p=0.03), had longer hospitalizations (4.9 vs 2.5 days, p=0.02), and were more likely to have required operative intervention (51.9% vs 32.3%, p=0.04). Similarly, patients identified with missed injuries had a higher ISS (15.2 vs 5.2, p<0.0001), greater length of stay (12.7 vs 2.5 days, p<0.0001), and were also more likely to be intubated (25.9% vs 3.6%, p <0.0001) or require critical care (48.1% vs 10.3%, p<0.0001). Seven missed injuries were in patients who were deemed non-accidental trauma (25.9%) and significantly altered their hospital course while 10 patients (37%) required operative intervention. On multivariate analysis, only ISS was found to be an independent risk factor for readmissions and missed injuries. Conclusions Missed injuries and unplanned readmissions were rare occurrences among our pediatric patient population. These events, however, did result in longer hospitalizations and additional procedures. Patients with multisystem injuries and compromised physical exam are at higher risk.

show abstract

Section: Discussionsupporting

confidence: 83%

Missed injuries and unplanned readmissions in pediatric trauma patients

Choi

Keller

2017

Journal of Pediatric Surgery

View full text Add to dashboard Cite

show abstract

“…Elsewhere, it has even been suggested that a certain low level of missed injury should be accepted, as to completely eliminate it would require an inappropriate allocation of resources such as consultant time and overuse of scans. 13 Whilst our sample size is comparable to many published missed injury series, it is not an especially large cohort and this combined with our low rate of missed injury meant that we only had five missed injury patients. Therefore, the power of the study to bring out risk factors for missed injury is limited.…”

Section: Discussionmentioning

confidence: 75%

Missed orthopaedic injuries in adult trauma patients at a major trauma centre

Roche

McDonald

Liu

et al. 2015

Trauma

View full text Add to dashboard Cite

Introduction: Despite advances in trauma care, missed injury remains a significant cause of morbidity and mortality in trauma worldwide. In England, few have published their missed injury rates and there are no recent data for London. In 2010 London trauma networks were restructured and the impact on missed injury rates is not known. This study aimed to determine the incidence of missed orthopaedic injury for adult trauma patients at St George's Hospital, London, and to analyse missed injuries and comment on risk factors. Method: Trauma patients were recorded prospectively at the daily trauma meeting from July to September 2012. The researcher attended clinical activities and reviewed the patient notes and radiology reports daily whilst each patient was an inpatient until discharge. Missed injuries were defined as fractures or dislocations discovered more than 12 h after arrival in the emergency department. The notes for missed injury patients were reviewed again at six months. Missed injury details were recorded/analysed. Results: Three hundred and forty three adult trauma patients were referred to trauma and orthopaedics in the threemonth study period; 5 (1.5%) had a missed injury and 148 (43.1%) had an ISS>15. All missed injuries occurred in these major trauma patients, giving an incidence of 5/148 (3.4%). Four were extremity injuries and one was cervical. All missed injury patients had a GCS of 15/15, were admitted outside normal working hours, were direct admissions and had wholebody CT. Conclusions: At 3.4% our missed injury incidence is comparable to those published from similar major trauma centres. This provides recent London data following the restructuring of trauma networks.

show abstract

“…Parents should also be alerted that some injuries may come to light weeks after the accident, 8 and this is particularly important in severely injured children. 30 …”

Section: Dealing With the Familiesmentioning

confidence: 99%

Management of Orthopaedic Injuries in Multiply Injured Child

Lahoti

Arya

2018

IJOO

View full text Add to dashboard Cite

Multiply injured child is a unique challenge to the medical communities worldwide. It is a leading cause of preventable mortality and morbidity in children. Common skeletal injuries include closed or open fractures of tibia and femur and pelvic injuries. Initial management focuses on saving life and then saving limb as per pediatric advanced life support and advanced trauma life support. Orthopedic management of open fracture includes splinting the limb, administration of prophylactic antibiotic, and surgical debridement of the wound when safe. However, gross contamination, compartment syndrome, and vascular injuries demand urgent attention.

show abstract

Ten-Year Retrospective Study of Delayed Diagnosis of Injury in Pediatric Trauma Patients at a Level II Trauma Center

Abstract: The rate of missed injuries remained relatively constant over the past 10 years at our institution. More severely injured patients are more likely to have missed injuries. Special attention to the lower extremities of the younger trauma patient may be warranted.

Cited by 18 publications

References 9 publications

Missed injuries and unplanned readmissions in pediatric trauma patients

Missed injuries and unplanned readmissions in pediatric trauma patients

Missed orthopaedic injuries in adult trauma patients at a major trauma centre

Management of Orthopaedic Injuries in Multiply Injured Child

Contact Info

Product

Resources

About