The effect of tertiary surveys on missed injuries in trauma: A systematic review

Gerben B. Keijzers, Georgios F. Giannakopoulos, Chris Del Mar, Fred C. Bakker, Leo M G Geeraedts

Research output: Contribution to journalReview articleResearchpeer-review

20 Citations (Scopus)

Abstract

Background: Trauma tertiary surveys (TTS) are advocated to reduce the rate of missed injuries in hospitalized trauma patients. Moreover, the missed injury rate can be a quality indicator of trauma care performance. Current variation of the definition of missed injury restricts interpretation of the effect of the TTS and limits the use of missed injury for benchmarking. Only a few studies have specifically assessed the effect of the TTS on missed injury. We aimed to systematically appraise these studies using outcomes of two common definitions of missed injury rates and long-term health outcomes.Methods: A systematic review was performed. An electronic search (without language or publication restrictions) of the Cochrane Library, Medline and Ovid was used to identify studies assessing TTS with short-term measures of missed injuries and long-term health outcomes. 'Missed injury' was defined as either: Type I) any injury missed at primary and secondary survey and detected by the TTS; or Type II) any injury missed at primary and secondary survey and missed by the TTS, detected during hospital stay. Two authors independently selected studies. Risk of bias for observational studies was assessed using the Newcastle-Ottawa scale.Results: Ten observational studies met our inclusion criteria. None was randomized and none reported long-term health outcomes. Their risk of bias varied considerably. Nine studies assessed Type I missed injury and found an overall rate of 4.3%. A single study reported Type II missed injury with a rate of 1.5%. Three studies reported outcome data on missed injuries for both control and intervention cohorts, with two reporting an increase in Type I missed injuries (3% vs. 7%, P<0.01), and one a decrease in Type II missed injuries (2.4% vs. 1.5%, P=0.01).Conclusions: Overall Type I and Type II missed injury rates were 4.3% and 1.5%. Routine TTS performance increased Type I and reduced Type II missed injuries. However, evidence is sub-optimal: few observational studies, non-uniform outcome definitions and moderate risk of bias. Future studies should address these issues to allow for the use of missed injury rate as a quality indicator for trauma care performance and benchmarking.

Original languageEnglish
Article number77
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume20
DOIs
Publication statusPublished - 29 Nov 2012

Fingerprint

Wounds and Injuries
Surveys and Questionnaires
Observational Studies
Benchmarking
Health
Outcome Assessment (Health Care)
Libraries
Publications
Length of Stay
Language

Cite this

Keijzers, Gerben B. ; Giannakopoulos, Georgios F. ; Del Mar, Chris ; Bakker, Fred C. ; Geeraedts, Leo M G. / The effect of tertiary surveys on missed injuries in trauma : A systematic review. In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012 ; Vol. 20.
@article{a1ccf60d62374d269f72e20cefc2ef25,
title = "The effect of tertiary surveys on missed injuries in trauma: A systematic review",
abstract = "Background: Trauma tertiary surveys (TTS) are advocated to reduce the rate of missed injuries in hospitalized trauma patients. Moreover, the missed injury rate can be a quality indicator of trauma care performance. Current variation of the definition of missed injury restricts interpretation of the effect of the TTS and limits the use of missed injury for benchmarking. Only a few studies have specifically assessed the effect of the TTS on missed injury. We aimed to systematically appraise these studies using outcomes of two common definitions of missed injury rates and long-term health outcomes.Methods: A systematic review was performed. An electronic search (without language or publication restrictions) of the Cochrane Library, Medline and Ovid was used to identify studies assessing TTS with short-term measures of missed injuries and long-term health outcomes. 'Missed injury' was defined as either: Type I) any injury missed at primary and secondary survey and detected by the TTS; or Type II) any injury missed at primary and secondary survey and missed by the TTS, detected during hospital stay. Two authors independently selected studies. Risk of bias for observational studies was assessed using the Newcastle-Ottawa scale.Results: Ten observational studies met our inclusion criteria. None was randomized and none reported long-term health outcomes. Their risk of bias varied considerably. Nine studies assessed Type I missed injury and found an overall rate of 4.3{\%}. A single study reported Type II missed injury with a rate of 1.5{\%}. Three studies reported outcome data on missed injuries for both control and intervention cohorts, with two reporting an increase in Type I missed injuries (3{\%} vs. 7{\%}, P<0.01), and one a decrease in Type II missed injuries (2.4{\%} vs. 1.5{\%}, P=0.01).Conclusions: Overall Type I and Type II missed injury rates were 4.3{\%} and 1.5{\%}. Routine TTS performance increased Type I and reduced Type II missed injuries. However, evidence is sub-optimal: few observational studies, non-uniform outcome definitions and moderate risk of bias. Future studies should address these issues to allow for the use of missed injury rate as a quality indicator for trauma care performance and benchmarking.",
author = "Keijzers, {Gerben B.} and Giannakopoulos, {Georgios F.} and {Del Mar}, Chris and Bakker, {Fred C.} and Geeraedts, {Leo M G}",
year = "2012",
month = "11",
day = "29",
doi = "10.1186/1757-7241-20-77",
language = "English",
volume = "20",
journal = "Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine",
issn = "1757-7241",
publisher = "BioMed Central",

}

The effect of tertiary surveys on missed injuries in trauma : A systematic review. / Keijzers, Gerben B.; Giannakopoulos, Georgios F.; Del Mar, Chris; Bakker, Fred C.; Geeraedts, Leo M G.

In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol. 20, 77, 29.11.2012.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - The effect of tertiary surveys on missed injuries in trauma

T2 - A systematic review

AU - Keijzers, Gerben B.

AU - Giannakopoulos, Georgios F.

AU - Del Mar, Chris

AU - Bakker, Fred C.

AU - Geeraedts, Leo M G

PY - 2012/11/29

Y1 - 2012/11/29

N2 - Background: Trauma tertiary surveys (TTS) are advocated to reduce the rate of missed injuries in hospitalized trauma patients. Moreover, the missed injury rate can be a quality indicator of trauma care performance. Current variation of the definition of missed injury restricts interpretation of the effect of the TTS and limits the use of missed injury for benchmarking. Only a few studies have specifically assessed the effect of the TTS on missed injury. We aimed to systematically appraise these studies using outcomes of two common definitions of missed injury rates and long-term health outcomes.Methods: A systematic review was performed. An electronic search (without language or publication restrictions) of the Cochrane Library, Medline and Ovid was used to identify studies assessing TTS with short-term measures of missed injuries and long-term health outcomes. 'Missed injury' was defined as either: Type I) any injury missed at primary and secondary survey and detected by the TTS; or Type II) any injury missed at primary and secondary survey and missed by the TTS, detected during hospital stay. Two authors independently selected studies. Risk of bias for observational studies was assessed using the Newcastle-Ottawa scale.Results: Ten observational studies met our inclusion criteria. None was randomized and none reported long-term health outcomes. Their risk of bias varied considerably. Nine studies assessed Type I missed injury and found an overall rate of 4.3%. A single study reported Type II missed injury with a rate of 1.5%. Three studies reported outcome data on missed injuries for both control and intervention cohorts, with two reporting an increase in Type I missed injuries (3% vs. 7%, P<0.01), and one a decrease in Type II missed injuries (2.4% vs. 1.5%, P=0.01).Conclusions: Overall Type I and Type II missed injury rates were 4.3% and 1.5%. Routine TTS performance increased Type I and reduced Type II missed injuries. However, evidence is sub-optimal: few observational studies, non-uniform outcome definitions and moderate risk of bias. Future studies should address these issues to allow for the use of missed injury rate as a quality indicator for trauma care performance and benchmarking.

AB - Background: Trauma tertiary surveys (TTS) are advocated to reduce the rate of missed injuries in hospitalized trauma patients. Moreover, the missed injury rate can be a quality indicator of trauma care performance. Current variation of the definition of missed injury restricts interpretation of the effect of the TTS and limits the use of missed injury for benchmarking. Only a few studies have specifically assessed the effect of the TTS on missed injury. We aimed to systematically appraise these studies using outcomes of two common definitions of missed injury rates and long-term health outcomes.Methods: A systematic review was performed. An electronic search (without language or publication restrictions) of the Cochrane Library, Medline and Ovid was used to identify studies assessing TTS with short-term measures of missed injuries and long-term health outcomes. 'Missed injury' was defined as either: Type I) any injury missed at primary and secondary survey and detected by the TTS; or Type II) any injury missed at primary and secondary survey and missed by the TTS, detected during hospital stay. Two authors independently selected studies. Risk of bias for observational studies was assessed using the Newcastle-Ottawa scale.Results: Ten observational studies met our inclusion criteria. None was randomized and none reported long-term health outcomes. Their risk of bias varied considerably. Nine studies assessed Type I missed injury and found an overall rate of 4.3%. A single study reported Type II missed injury with a rate of 1.5%. Three studies reported outcome data on missed injuries for both control and intervention cohorts, with two reporting an increase in Type I missed injuries (3% vs. 7%, P<0.01), and one a decrease in Type II missed injuries (2.4% vs. 1.5%, P=0.01).Conclusions: Overall Type I and Type II missed injury rates were 4.3% and 1.5%. Routine TTS performance increased Type I and reduced Type II missed injuries. However, evidence is sub-optimal: few observational studies, non-uniform outcome definitions and moderate risk of bias. Future studies should address these issues to allow for the use of missed injury rate as a quality indicator for trauma care performance and benchmarking.

UR - http://www.scopus.com/inward/record.url?scp=84870056174&partnerID=8YFLogxK

U2 - 10.1186/1757-7241-20-77

DO - 10.1186/1757-7241-20-77

M3 - Review article

VL - 20

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

SN - 1757-7241

M1 - 77

ER -