Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

An analysis of missed injuries in patients with severe trauma

  • EunGyu, Ju (National Trauma Center, National Medical Center) ;
  • Sun Young, Baek (Department of Surgery, National Trauma Center, National Medical Center) ;
  • Sung Soo, Hong (Department of Surgery, National Trauma Center, National Medical Center) ;
  • Younghwan, Kim (Department of Surgery, National Trauma Center, National Medical Center) ;
  • Seok Hwa, Youn (Department of Surgery, National Trauma Center, National Medical Center)
  • Received : 2022.04.07
  • Accepted : 2022.06.06
  • Published : 2022.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

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 27.5% 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.

Keywords

References

  1. Statistics Korea. Statistical yearbook of causes of death in 2020 [Internet]. Daejeon: Statistics Korea; 2021 [cited 2021 Oct 18]. Available from: https://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board?bmode=read&bSeq=&aSeq=403046.
  2. Ha JW, Han GT, Kim DW, Im HS, Choi JG, Yuk TM. A study on the burden of medical expenses for patients with severe trauma (report no. 2017-20-033). Goyang: National Health Insurance Service Ilsan Hospital; 2017.
  3. Yu BC, Chung M, Lee GJ, et al. Analysis of KTDB registered trauma patients from a single trauma center in Korea. J Trauma Inj 2015;28:123-8. https://doi.org/10.20408/jti.2015.28.3.123
  4. Jo JY, Hwang YS, Kweon SH. A community-based study of severe trauma, death and disability: 2019. Cheongju: Korea Disease Control and Prevention Agency; 2021.
  5. Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent) 2010;23:349-54.
  6. Ministry of Health and Welfare. Assessment of preventable trauma mortality rate and activation of trauma center operation. Sejong: Ministry of Health and Welfare; 2017.
  7. Zamboni C, Yonamine AM, Faria CE, Filho MA, Christian RW, Mercadante MT. Tertiary survey in trauma patients: avoiding neglected injuries. Injury 2014;45 Suppl 5:S14-7.
  8. Association for the Advancement of Automotive Medicine (AAAM). Abbreviated Injury Scale 2015 released. Chicago: AAAM; 2016.
  9. Sathy AK, Starr AJ, Smith WR, et al. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg Am 2009;91:2803-10. https://doi.org/10.2106/JBJS.H.00598
  10. Houshian S, Larsen MS, Holm C. Missed injuries in a level I trauma center. J Trauma 2002;52:715-9. https://doi.org/10.1097/00005373-200204000-00018
  11. Pfeifer R, Pape HC. Missed injuries in trauma patients: a literature review. Patient Saf Surg 2008;2:20.
  12. Tammelin E, Handolin L, Soderlund T. Missed injuries in polytrauma patients after trauma tertiary survey in trauma intensive care unit. Scand J Surg 2016;105:241-7. https://doi.org/10.1177/1457496915626837
  13. Joseph A. Sedation of the trauma patient in the intensive care unit. J Emerg Crit Care Med 2018;2:8.
  14. Thomson CB, Greaves I. Missed injury and the tertiary trauma survey. Injury 2008;39:107-14. https://doi.org/10.1016/j.injury.2007.07.030
  15. Gordic S, Alkadhi H, Hodel S, et al. Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. Br J Radiol 2015;88:20140616.
  16. Lee KJ, Jung K, Kim J, Kwon J. Bone scan as a screening test for missed fractures in severely injured patients. Orthop Traumatol Surg Res 2014;100:953-7.