Undetected injuries: A preventable cause of increased morbidity and mortality

Muckart, D. J. J.; Thomson, Sandie

doi:10.1016/0002-9610(91)90260-k

Cited by 37 publications

(18 citation statements)

References 18 publications

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“…In this series, the missed injury rate was 1%, with a mortality rate of 33%, which falls within the 17% to 44% reported in the literature. 6,7 Other series have reported missed injuries to occur in 2% of abdominal trauma 7 and in 9% to 65% of all injuries. 3,7,9 The negative laparotomy rate of only 1.2% with zero mortality in this series is encouraging compared with the reported negative laparotomy rate of 13% to 57% [35][36][37] and the mortality rate of 6.3%.…”

Section: Discussionmentioning

confidence: 97%

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Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

Mnguni

Muckart

Madiba

2012

International Surgery

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Abdominal injury as a result of both blunt and penetrating trauma has an appreciable mortality rate from hemorrhage and sepsis. In this article, we present our experience with the management of abdominal trauma in Durban and investigate factors that influence outcome. We performed a prospective study of patients with abdominal trauma in one surgical ward at King Edward VIII Hospital in Durban over a period of 7 years, from 1998 through 2004. Demographic details, cause of injury, delay before surgery, clinical presentation, findings at surgery, management and outcome were documented. There were 488 patients with abdominal trauma with a mean age of 29.2 ± 10.7 years. There were 440 penetrating injuries (240 firearm wounds; 200 stab wounds) and 48 blunt injuries. The mean delay before surgery was 11.7 ± 16.4 hours, and 55 patients (11%) presented in shock. Four hundred and forty patients underwent laparotomy, and 48 were managed nonoperatively. The Injury Severity Score was 11.1 ± 6.7, and the New Injury Severity Score was 17.1 ± 11.1. One hundred and thirty-seven patients (28%) were admitted to the intensive care unit (ICU), with a mean ICU stay of 3.6 ± 5.5 days. One hundred and thirty-two patients developed complications (28%), and 52 (11%) died. Shock, acidosis, increased transfusion requirements, number of organs injured, and injury severity were all associated with higher mortality. Delay before surgery had no influence on outcome. Hospital stay was 9.2 ± 10.8 days. The majority of abdominal injuries in our environment are due to firearms. Physiological instability, mechanism of injury, severity of injury, and the number of organs injured influence outcome.

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Section: Discussionmentioning

confidence: 97%

“…[1][2][3][4][5][6][7][8] Hemorrhage from the liver or pelvis, especially concealed hemorrhage, is a major contributor to mortality after trauma. 4,8 Appropriate and expeditious assessment and investigation of individuals with traumatic injury facilitate definitive management and minimize the risk of complications.…”

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confidence: 99%

Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

Mnguni

Muckart

Madiba

2012

International Surgery

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“…Nevertheless, an effect has been reported in the literature for some criteria used in this study. Several authors have noted a negative impact of delayed diagnosis on outcome after severe trauma [30,31,32,33,34]. Copes et al [18] observed an improvement in rapid operation in cases of abdominal injury.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers

Ruchholtz

Waydhas

Lewan

et al. 2002

Intensive Care Medicine

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“…Mehrere Autoren konnten einen negativen Einfluss verzögert diagnostizierter Läsionen auf das Behandlungsresultat nachweisen [20,24,34,41,51,52].…”

Section: Prozessanalyseunclassified

Interdisziplinäres Qualitätsmanagement in der Behandlung schwerverletzter Patienten

Ruchholtz¹,

Waydhas²,

Aufmkolk³

et al. 2001

Der Unfallchirurg

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A multidisciplinary quality management system (QMS) for the early treatment of severely injured patients was validated in a trauma center in Germany. In the presented prospective study a QMS developed at another trauma center was implemented at the department of trauma surgery of the University of Essen for the presented study. The essential elements of the QMS were the establishment of (1) an adequate protocol for documentation, (2) 20 criteria for the assessment of treatment quality, (3) regular statistical analysis of treatment quality and (4) a quality circle comprising all medical specialties for data discussion. From 5/98-9/99 a cohort of 447 patients with an average injury severity score (ISS) of 22 +/- 17 was treated in the emergency department. The impact of the QMS was assessed in 4 periods (1: 5/1998-8/1998; 2: 9-12/1998; 3: 1-4/1999; 4: 5-8/1999). The quality circle met 8 times. For the improvement of the process 16 long-term changes were introduced. In 60% (n = 12) of the 20 assessment criteria significant improvements were detected. In diagnostics there were significant reductions of the time needed for basic radiological and sonographic check-up (from 24 +/- 12 min in the first to 14 +/- 8 min in the last period) and of the duration until performance of a cranial computed tomography in severe traumatic brain injury (sTBI; from 45 +/- 22 to 28 +/- 8 min). The rate of delayed diagnoses remained low (4% in the first, 5% in the last period). Further positive changes were the time savings in transfusion (from 35 +/- 20 to 20 +/- 4 min) and emergency operations (from 67 +/- 20 to 48 +/- 4 min) in hemorrhagic shock as well as for craniotomies (77 +/- 41 to 54 +/- 19 min) in sTBI. Apart from the significant time reductions other improvements were found. Overall mortality was diminished from 17% in the first to 10% in the last observation period. In conclusion the study revealed that the quality of the early therapy of severely injured patients was significantly improved by implementation of a multidisciplinary quality management system especially with respect to treatment efficiency.

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Undetected injuries: A preventable cause of increased morbidity and mortality

Cited by 37 publications

References 18 publications

Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers

Interdisziplinäres Qualitätsmanagement in der Behandlung schwerverletzter Patienten

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