Tertiary survey in trauma patients: avoiding neglected injuries

Zamboni, Caio; Yonamine, Alexandre Maris; Faria, Carlos Eduardo Nunes; Filho, Marco Antonio Machado; Christian, Ralph Walter; Mercadante, Marcelo Tomanik

doi:10.1016/s0020-1383(14)70014-2

Cited by 18 publications

(34 citation statements)

References 8 publications

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“…There was rather a slight difference to the disadvantage of the high-grade CJI in this regard. It is possible that in the latter case not only is the CJI more severe but also that other concomitant injuries come to the forefront so that they tend to draw more attention than the CJI 44 , 48 .…”

Section: Discussionmentioning

confidence: 99%

“…The relatively high number of primarily missed injuries could be caused by concomitant injuries, which initially require increased attention and may have resulted in a distraction from the CJI 44 , 48 . Since the patient cohort consists of rather severe injuries, comparatively severe concomitant injuries could also be assumed to have occurred.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Bakır

Lefering

Haralambiev

et al. 2020

Sci Rep

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Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Bakır

Lefering

Haralambiev

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Four of the newly diagnosed injuries were classified as relevant but did not lead to a change of further treatment regimen. Zamboni et al reported 7.6% newly diagnosed injuries in the course of inpatient stay, whereby at this study, the diagnoses were only mentioned without a calculation of AIS or ISS [ 25 ]. Moreover, Stephan et al reported new diagnoses in 35/630 patients (5.56%) during a 23-h patient surveillance period, of which 14 (2.22%) were relevant [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Evidence of Prolonged Monitoring of Trauma Patients Admitted via Trauma Resuscitation Unit without Primary Proof of Severe Injuries

Heinrich

Lany

Anastasopoulou

et al. 2020

JCM

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Introductio: Although management of severely injured patients in the Trauma Resuscitation Unit (TRU) follows evidence-based guidelines, algorithms for treatment of the slightly injured are limited. Methods: All trauma patients in a period of eight months in a Level I trauma center were followed. Retrospective analysis was performed only in patients ≥18 years with primary TRU admission, Abbreviated Injury Scale (AIS) ≤ 1, Maximum Abbreviated Injury Scale (MAIS) ≤ 1 and Injury Severity Score (ISS) ≤3 after treatment completion and ≥24 h monitoring in the units. Cochran’s Q-test was used for the statistical evaluation of AIS and ISS changes in units. Results: One hundred and twelve patients were enrolled in the study. Twenty-one patients (18.75%) reported new complaints after treatment completion in the TRU. AIS rose from the Intermediate Care Unit (IMC) to Normal Care Unit (NCU) 6.2% and ISS 6.9%. MAIS did not increase >2, and no intervention was necessary for any patient. No correlation was found between computed tomography (CT) diagnostics in TRU and AIS change. Conclusions: The data suggest that AIS, MAIS and ISS did not increase significantly in patients without a severe injury during inpatient treatment, regardless of the type of CT diagnostics performed in the TRU, suggesting that monitoring of these patients may be unnecessary.

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“…An additional Trauma Tertiary Survey (TTS), which comprises an in-hospital general physical re-examination and a review of all diagnostic investigations within 24 h, proofed to be successful in reducing the number of missed injuries in multitrauma patients: patients with an Injury Severity Score (ISS) higher than 16 [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The yield of tertiary survey in patients admitted for observation after trauma

Aert

Dongen

Berende

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Existing literature on trauma tertiary survey (TTS) focusses on multitrauma patients. This study examines the yield of the TTS in trauma patients with minor (AIS 1) or moderate (AIS 2) injury for which immediate hospitalization is not strictly indicated. Method A single center retrospective cohort study was performed in a level II trauma center. All hospitalized trauma patients with an abbreviate injury score (AIS) of one or two at the primary and secondary survey were included. The primary outcome was defined as any missed injury found during TTS (Type 1). Secondary outcomes were defined as any missed injury found after TTS but during admission (Type 2); overall missed injury rate; mortality and hospital length of stay. Results Out of 388 included patients, 12 patients (3.1%) had a type 1 missed injury. ISS and alcohol consumption were associated with an increased risk for type 1 missed injuries (resp. OR = 1.4, OR = 5.49). A type 2 missed injury was only found in one patient. This concerned the only case of trauma related mortality. Approximately one out of five patients were admitted for more than 2 days. These patients were significantly older (66 vs. 41 years, p < 0.001), had a higher ISS (4 vs. 3, p = 0.007) and ASA score, 3-4 vs. 1-2 (42.5% vs. 12.6%, p < 0.001). Conclusion TTS showed a low rate of missed injuries in trauma patients with minor or moderate injury. TTS helped to prevent serious damage in two out of 388 patients (0.5%). ISS and alcohol consumption were associated with finding missed injury during TTS.

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Tertiary survey in trauma patients: avoiding neglected injuries

Cited by 18 publications

References 8 publications

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Evidence of Prolonged Monitoring of Trauma Patients Admitted via Trauma Resuscitation Unit without Primary Proof of Severe Injuries

The yield of tertiary survey in patients admitted for observation after trauma

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