The impact of clinically undiagnosed injuries on survival estimates

Gedeborg, Rolf; Thiblin, Ingemar; Byberg, Liisa; Wernroth, Lisa; Michaëlsson, Karl

doi:10.1097/ccm.0b013e318194b164

Cited by 20 publications

(19 citation statements)

References 27 publications

(19 reference statements)

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“…Significant injuries missed during the primary survey have been named the "nemesis of the trauma surgeon" [6] and may be the deciding factor for survival or death [7-11]. There is still a high degree of variability in the reported incidence of missed injuries ranging from 1 up to 39% [12], stressing the need for continuing improvement of trauma algorithms.…”

Section: Introductionmentioning

confidence: 99%

Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study

Hutter

Woltmann

Hierholzer

et al. 2011

Scand J Trauma Resusc Emerg Med

105

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IntroductionSingle-pass, whole-body computed tomography (pan-scan) remains a controversial intervention in the early assessment of patients with major trauma. We hypothesized that a liberal pan-scan policy is mainly an indicator of enhanced process quality of emergency care that may lead to improved survival regardless of the actual use of the method.MethodsThis retrospective cohort study included consecutive patients with blunt trauma referred to a trauma center prior to (2000 to 2002) and after (2002 to 2007) the introduction of a liberal single-pass pan-scan policy. The overall mortality between the two periods was compared and stratified according to the availability and actual use of the pan-scan. Logistic regression analysis was employed to adjust mortality estimates for demographic and injury-related independent variables.ResultsThe study comprised 313 patients during the pre-pan-scan period, 223 patients after the introduction of the pan-scan policy but not undergoing a pan-scan and 608 patients undergoing a pan-scan. The overall mortality was 23.3, 14.8 and 7.9% (P < 0.001), respectively. By univariable logistic regression analysis, both the availability (odds ratio (OR) 0.57, 95% confidence interval (CI): 0.36 to 0.90) and the actual use of the pan-scan (OR 0.28, 95% CI: 0.19 to 0.42) were associated with a lower mortality. The final model contained the Injury Severity Score, the Glasgow Coma Scale, age, emergency department time and the use of the pan-scan. 2.7% of the explained variance in mortality was attributable to the use of the pan-scan. This contribution increased to 7.1% in the highest injury severity quartile.ConclusionsIn this study, a liberal pan-scan policy was associated with lower trauma mortality. The causal role of the pan-scan itself must be interpreted in the context of improved structural and process quality, is apparently moderate and needs further investigation with regard to the diagnostic yield and changes in management decisions. (The Pan-Scan for Trauma Resuscitation [PATRES] Study Group, ISRCTN35424832 and ISRCTN41462125)

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Section: Introductionmentioning

confidence: 99%

Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study

Hutter

Woltmann

Hierholzer

et al. 2011

Scand J Trauma Resusc Emerg Med

105

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“…A missed injury may attract attention as the most memorable event in a patient's clinical course, clouding the brave efforts of the trauma team [4]. To reduce errors, hospitals need effective means of identifying errors and error-associated deaths, which have been found to be 2.7-6.5% [1,5]. It is true that there is a general disinclination of physicians to admit and account for their errors.…”

Section: Introductionmentioning

confidence: 99%

Predictors of missed injuries in hospitalized trauma patients in the emergency department

Emet

Sarıtaş

Acemoğlu

et al. 2010

Eur J Trauma Emerg Surg

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“…Whereas cervicothoracic vascular injury was uncommon in this study, it appears to be frequent elsewhere, and may be associated with upper limb injuries [16]. These are regarded as serious injuries, as they carry a reported mortality rate of 30-50%, [17] with autopsy statistics suggesting substantial bias of survival estimates for vascular injuries in the thorax [18]. Although fractures of the first rib with posterior displacement are suggestive of vascular injury, those without mediastinal abnormality on chest X-ray are less likely to have a significant thoracic vascular injury [16].…”

Section: Discussionmentioning

confidence: 59%