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- An analysis of missed injuries in patients with severe trauma
- EunGyu Ju, Sun Young Baek, Sung Soo Hong, Younghwan Kim, Seok Hwa Youn
- J Trauma Inj. 2022;35(4):248-254. Published online September 14, 2022
- DOI: https://doi.org/10.20408/jti.2022.0017
- 2,032 View
- 72 Download
- 1 Citations
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Abstract
PDF - Purpose
To analyze the data of trauma patients with undetected injuries at the time of initial resuscitation during the primary and secondary surveys.
Methods
We retrospectively reviewed the medical records of 807 patients who were hospitalized at the National Trauma Center, Seoul, Korea from June 1, 2019 to June 30, 2021.
Results
In trauma patients with an Injury Severity Score ≥16 accounted for 38.0% in the non-missed injury group (non-MIG), but this rate was considerably higher at 71.2% in MIG. The mean hospitalization longer in MIG (50.90±39.56) than in non-MIG (24.74±26.11). The proportion of patients with missed injuries detected through tertiary trauma survey (TTS) was 28 patients (23.5%) within 24 hours, 90 patients (75.6%) after 24 hours to before discharge. The majority of missed injuries were fractures (82.4%) and ligament tears (8.4%), which required consultation with the orthopedic department. The final diagnoses of missed injuries were confirmed by computed tomography (44.5%), magnetic resonance imaging (19.3%), X-ray (19.3%), bone scan (11.8%), and physical examination (5.0%).
Conclusions
TTS is considered a useful process for detecting missed injuries that were not identified at the time of initial resuscitation in the primary and secondary surveys. In the future, to detect missed injuries quickly, it is necessary to develop a suitable TTS program for each trauma center. In addition, further research is needed to verify the effectiveness of the protocolized TTS and survey chart to improve the effectiveness of TTS. -
Summary
Citations
Citations to this article as recorded by
- Tertiary Trauma Survey on Emergency Department Observational Units: A Systematic Literature Review
Tamkeen Pervez, Mehreen Malik
Cureus.2024;[Epub] CrossRef
- Clinical Effects of Intra-Abdominal Pressure in Critically Ill Trauma Patients
- Dong Yeon Ryu, Hohyun Kim, June Pill Seok, Chan Kyu Lee, Kwang-Hee Yeo, Seon-Uoo Choi, Jae-Hun Kim, Hyun Min Cho
- J Trauma Inj. 2019;32(2):86-92. Published online June 30, 2019
- DOI: https://doi.org/10.20408/jti.2018.052
- 3,770 View
- 81 Download
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Abstract
PDF
Purpose There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population.
Methods Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8?12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as IAP ≥12 mmHg. Abdominal compartment syndrome was defined as IAP ≥20 mmHg plus ≥1 new organ failure. The main outcome measure was in-hospital mortality.
Results According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with IAP ≥20 mmHg than in those with IAP <20 mmHg (16 vs. 5,
p =0.049). The hospital mortality rate was 27.3%. Patients with a maximum IAP ≥20 mmHg exhibited significantly higher hospital mortality rates (p =0.006). Non-survivors had higher maximum and mean IAP values.Conclusions Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.
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