Tertiary survey in polytrauma patients should be an ongoing process |
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| Affiliation: | 1. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;2. Utrecht Traumacenter, Utrecht, The Netherlands;1. Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, United States;2. Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan;1. Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia;2. Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria 3121, Australia;3. Centre for Limb Reconstruction, The Epworth Centre, Richmond, Victoria 3121, Australia;4. Department of Surgery, Southern Clinical School, Monash University, Clayton, Victoria 3168, Australia;1. Department of Trauma Surgery, Trauma Center, Murnau, Germany;2. Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria;3. Department of Trauma Surgery, University Hospital, Zurich, Switzerland;1. Department of Trauma, Hand and Reconstructive Surgery, University Medical center Marburg, Baldingerstraße, 35043 Marburg, Germany;2. Institute for Medical Biometry and Epidemiology, Philipps-University, Marburg, Germany;3. Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany;1. Core surgical trainee, Mersey Deanery, UK;2. Specialist registrar in trauma and orthopaedics, Mersey Deanery, UK;3. Consultant upper limb trauma and orthopaedic surgeon, Countess of Chester Hospital, UK |
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| Abstract: | IntroductionDue to prioritisation in the initial trauma care, non-life threatening injuries can be overlooked or temporally neglected. Polytrauma patients in particular might be at risk for delayed diagnosed injuries (DDI). Studies that solely focus on DDI in polytrauma patients are not available. Therefore the aim of this study was to analyze DDI and determine risk factors associated with DDI in polytrauma patients.MethodsIn this single centre retrospective cohort study, patients were considered polytrauma when the Injury Severity Score was ≥16 as a result of injury in at least 2 body regions. Adult polytrauma patients admitted from 2007 until 2012 were identified. Hospital charts were reviewed to identify DDI.Results1416 polytrauma patients were analyzed of which 12% had DDI. Most DDI were found during initial hospital admission after tertiary survey (63%). Extremities were the most affected regions for all types of DDI (78%) with the highest intervention rate (35%). Most prevalent DDI were fractures of the hand (54%) and foot (38%). In 2% of all patients a DDI was found after discharge, consisting mainly of injuries other than a fracture. High energy trauma mechanism (OR 1.8, 95% CI 1.2–2.7), abdominal injury (OR 1.5, 95% CI 1.1–2.1) and extremity injuries found during initial assessment (OR 2.3, 95% CI 1.6–3.3) were independent risk factors for DDI.ConclusionIn polytrauma patients, most DDI were found during hospital admission but after tertiary survey. This demonstrates that the tertiary survey should be an ongoing process and thus repeated daily in polytrauma patients. Most frequent DDI were extremity injuries, especially injuries of the hand and foot. |
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| Keywords: | Polytrauma Delayed diagnosed injuries Tertiary survey |
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