The Impact of the Tertiary Survey in an Established Trauma Program

Abstract

Introduction The trauma tertiary survey (TTS) was first described in 1990 and is recognized as an essential practice in trauma care. The TTS remains effective in detecting secondary injuries in the modern era. Methods Trauma patients discharged between August 1, 2016, and December 31, 2016, were identified in our trauma registry. Collected data include TTS completion rates, detection of injuries, type of provider, and timing. TTS documentation was qualitatively evaluated. Results Out of 407 patients, 264 patients (65%) received a TTS. Injury detection rate was 1.1.%. Average time to TTS was 41 hours. TTS were completed by resident physicians (46%) and advanced practice providers (APPs; 46%). TTS documentation was more complete for APPs than for resident physicians. Conclusion TTS remains an integral component of modern trauma care. Ongoing education on the significance of TTS and the importance of thorough documentation is essential. Provision of real-time feedback to providers is also critical for improving current practices.

The Tertiary Survey as a Quality Improvement Initiative in Pediatric Trauma Care

“…The measurable primary outcome of delayed and missed injuries found during TTS demonstrates an improvement in quality of care and reduction in overall morbidity in pediatric trauma patients. [11][12][13][14][15][16] The identification of these injuries prior to discharge may prevent readmission, unnecessary return to the emergency department, and excessive outpatient visits. [11][12][13][14][15][16] Goals of TTS in terms of management and quality of care are outlined in Table 4.…”

“…7 An increasing number of institutions have employed an additional tertiary trauma survey (TTS) 24 to 72 hours following admission with the goals of capturing comorbidities, identifying missed or delayed injuries, and risk-stratifying trauma patients. 4,[8][9][10][11][12][13] TTS has been demonstrated as an integral quality improvement measure and a component of trauma care in the adult trauma population. [11][12][13][14][15][16] However, the application of TTS in the pediatric trauma center has yet to be standardized and is not well-defined in pediatric trauma literature.…”

“…4,[8][9][10][11][12][13] TTS has been demonstrated as an integral quality improvement measure and a component of trauma care in the adult trauma population. [11][12][13][14][15][16] However, the application of TTS in the pediatric trauma center has yet to be standardized and is not well-defined in pediatric trauma literature. 1,3 The TTS consists of a thorough history and physical exam, along with a review of all diagnostic laboratory and imaging studies performed from the time of admission.…”

Characteristics of patients with hip fractures and comorbid fall‐related injuries in the emergency department

“…Even in trauma centers, it was conducted only in 65% of patients. 11 To our knowledge, no previous studies have investigated the frequency of fall-related injuries accompanied with hip fractures in the ED. It is important to know the epidemiological data because neglecting comorbid fall-related injuries with hip fracture results in delayed treatment and worse outcomes.…”

“…However, whole‐body survey is not always conducted in trauma including hip fracture. Even in trauma centers, it was conducted only in 65% of patients 11 …”