A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey

Gerben B. Keijzers, Don Campbell, Jeffrey Hooper, Nerolie Bost, Julia Crilly, Michael Craig Steele, Chris Del Mar, Leo M G Geeraedts

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Abstract

Objective: This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure. Methods: Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March-October 2009 (preformalisation of TTS) and December 2009-September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months. Results: A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P < 0.001). Functional outcomes for both cohorts were similar at 1 and 6 months follow-up. Conclusions: This is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.

Original languageEnglish
Pages (from-to)222-232
Number of pages11
JournalWorld Journal of Surgery
Volume38
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Wounds and Injuries
Surveys and Questionnaires
Cohort Studies
Outcome Assessment (Health Care)

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Keijzers, G. B., Campbell, D., Hooper, J., Bost, N., Crilly, J., Steele, M. C., ... Geeraedts, L. M. G. (2014). A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey. World Journal of Surgery, 38(1), 222-232. https://doi.org/10.1007/s00268-013-2226-z
Keijzers, Gerben B. ; Campbell, Don ; Hooper, Jeffrey ; Bost, Nerolie ; Crilly, Julia ; Steele, Michael Craig ; Del Mar, Chris ; Geeraedts, Leo M G. / A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey. In: World Journal of Surgery. 2014 ; Vol. 38, No. 1. pp. 222-232.
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abstract = "Objective: This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure. Methods: Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March-October 2009 (preformalisation of TTS) and December 2009-September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months. Results: A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 {\%}, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 {\%}, P = 0.43), and 6 months (3.8 vs. 3.3 {\%}, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 {\%}, P < 0.001). Functional outcomes for both cohorts were similar at 1 and 6 months follow-up. Conclusions: This is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates >15 {\%}. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 {\%}), this did not decrease missed injury rates.",
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A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey. / Keijzers, Gerben B.; Campbell, Don; Hooper, Jeffrey; Bost, Nerolie; Crilly, Julia; Steele, Michael Craig; Del Mar, Chris; Geeraedts, Leo M G.

In: World Journal of Surgery, Vol. 38, No. 1, 01.2014, p. 222-232.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Campbell, Don

AU - Hooper, Jeffrey

AU - Bost, Nerolie

AU - Crilly, Julia

AU - Steele, Michael Craig

AU - Del Mar, Chris

AU - Geeraedts, Leo M G

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N2 - Objective: This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure. Methods: Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March-October 2009 (preformalisation of TTS) and December 2009-September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months. Results: A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P < 0.001). Functional outcomes for both cohorts were similar at 1 and 6 months follow-up. Conclusions: This is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.

AB - Objective: This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure. Methods: Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March-October 2009 (preformalisation of TTS) and December 2009-September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months. Results: A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P < 0.001). Functional outcomes for both cohorts were similar at 1 and 6 months follow-up. Conclusions: This is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.

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