Incidence and predictors of missed injuries in trauma patients in the initial hot report of whole-body CT scan |
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| Authors: | Eurin M Haddad N Zappa M Lenoir T Dauzac C Vilgrain V Mantz J Paugam-Burtz C |
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| Affiliation: | 1. Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Department of Anesthesiology and Critical Care, 92110 Clichy-la-Garenne, France;2. Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Department of Radiology, 92110 Clichy-la-Garenne, France;3. Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Department of Trauma and Orthopedic Surgery, 92110 Clichy-la-Garenne, France;4. INSERM, U773, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris F-75018, France;5. Univ Paris Diderot, Sorbonne Paris Cité, Paris, France;1. Department of Anaesthesia, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK;2. Patient Safety Research Unit, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK;1. Registrar Trauma & Orthopaedics, Department of Trauma & Orthopaedics, Cheltenham General Hospital, United Kingdom;2. Consultant Orthopaedic Surgeon, Specialist in Foot & Ankle Surgery, Cheltenham General Hospital, United Kingdom;1. Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany;2. Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;3. Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany;1. Klinikum rechts der Isar, Technical University Munich – TUM, Department of Trauma Surgery, Ismaninger Str. 22, D-81675 Munich, Germany;2. University Hospital Marburg, Department of Trauma, Hand and Reconstructive Surgery, Campus Marburg, Baldingerstraße, D-35043 Marburg, Germany;3. Klinikum rechts der Isar, Technical University Munich – TUM, Institute of Radiology, Ismaninger Str. 22, D-81675 Munich, Germany;4. Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany |
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| Abstract: | BackgroundWhole-body CT scan is the cornerstone of trauma-related injury assessment. Several lines of evidence indicate that significant number of injuries may remain undetected after the initial hot report of CT. Missed injuries (MI) represent an important issue in trauma patients, for they may increase morbidity, mortality and costs. The aim of this study was to examine incidence and predictors of MI in trauma patients undergoing whole-body CT scan.Methods177 CT scan performed upon admission of trauma patients during year 2005 were reviewed by a radiologist blinded to patient's initial data. MI was defined as injuries not written in the initial report. Patients with and without MI were compared to determine predictors of MI by multivariable analysis.Results157 MI were diagnosed in 85 (47%) patients. MI was predominantly encoded AIS 2 (57%) or 3 (29%). Patients with MI had significantly higher SAPSII, higher ISS and were more frequently sedated. Age over 50 years (OR: 4.37, p = 0.003) and ISS over 14 (OR: 4.17, p < 0.0001) were independent predictors of MI. Median ISS after encoding MI was significantly higher than initial ISS (22 vs. 20 p < 0.0001). After adjustment for severity, mortality and length of stay were not different between patients with or without MI.ConclusionTrauma patients, especially aged and severe, experienced a high rate of missed injuries in the initial hot report which appeared to be predominantly minor and musculoskeletal, advocating a CT scan second reading. |
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