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

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Leo MG Geeraedts²  Fred C Bakker²  Chris Del Mar¹  Georgios F Giannakopoulos²  Gerben B Keijzers³ 

[1] Professor of Public Health, School of Medicine, Bond University, Gold Coast, Queensland, Australia;Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands;Assistant Professor in Emergency Medicine, School of Medicine, Bond University, Gold Coast, Queensland, Australia

关键词: Quality of care;    Patient safety;    Multiple trauma;    Missed injury;    Tertiary survey;   

Others  :  826287
DOI  :  10.1186/1757-7241-20-77

 received in 2012-07-07, accepted in 2012-11-22,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Keijzers et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Gruen RL, Gabbe BJ, Stelfox HT, Cameron PA: Indicators of the quality of trauma care and the performance of trauma systems. Br J Surg 2012, 99(Suppl 1):97-104.
• [2]Stelfox HT, Straus SE, Nathens A, Bobranska-Artiuch B: Evidence for quality indicators to evaluate adult trauma care: a systematic review. Crit Care Med 2011, 39:846-859.
• [3]Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI: The tertiary trauma survey: a prospective study of missed injury. J Trauma 1990, 30:666-670.
• [4]Frawley PA: Missed injuries in the multiply traumatized. Aust N Z J Surg 1993, 63:935-939.
• [5]Aaland MO, Smith K: Delayed diagnosis in a rural trauma center. Surgery 1996, 120:774-779.
• [6]Robertson R, Mattox R, Collins T, Parks-Miller C, Eidt J, Cone J: Missed injuries in a rural trauma center. Am J Surg 1996, 172:564-567.
• [7]Furnival RA, Woodward GA, Schunk JE: Delayed diagnosis of injury in pediatric trauma. Pediatrics 1996, 98:56-62.
• [8]Janjua KJ, Sugrue M, Deane SA: Prospective evaluation of early missed injuries and the role of tertiary trauma survey. J Trauma 1998, 44:1000-1007.
• [9]Buduhan G, Donna I, McRitchie: Missed injuries in patients with multiple trauma. J Trauma 2000, 49:600-605.
• [10]Houshian S, Larsen MS, Holm C: Missed injuries in a level I trauma center. J Trauma 2002, 52:715-719.
• [11]Biffl WL, Harrington DT, Cioffi WG: Implementation of a tertiary trauma survey decreases missed injuries. J Trauma 2003, 54:38-44.
• [12]Vles WJ, Veen EJ, Roukema JA, Meeuwis JD, Leenen LP: Consequences of delayed diagnoses in trauma patients: a prospective study. J Am Coll Surg 2003, 197:596-602.
• [13]Soundappan SV, Holland AJ, Cass DT: Role of an extended tertiary survey in detecting missed injuries in children. J Trauma 2004, 57:114-118.
• [14]Brooks A, Holroyd B, Riley B: Missed injury in major trauma patients. Injury 2004, 35:407-410.
• [15]Albrektsen SB, Thomsen JL: Detection of injuries in traumatic deaths: the significance of medico-legal autopsy. Forensic Sci Int 1989, 42:135-143.
• [16]Stothert JC Jr, Gbaanador GB, Herndon DN: The role of autopsy in death resulting from trauma. J Trauma 1990, 30:1021-1026.
• [17]Welch HG, Schwartz LM, Woloshin S: Overdiagnosed. Making people sick in the pursuit of health. Boston Mass: Beacon Press; 2011.
• [18]Higgins JP, Thompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med 2002, 21:1539-1558.
• [19]Higgins JP, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003, 327:557-560.
• [20]Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P: The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in metaanalyses. 2011. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp webcite
• [21]Ursic C, Curtis K, Zou Y, Black D: Improved trauma patient outcomes after implementation of a dedicated trauma admitting service. Injury 2007, 38:112-117.
• [22]Hoff WS, Sicoutris CP, Lee SY, Rotondo MF, Holstein JJ, Gracias VH, Pryor JP, Reilly PM, Doroski KK, Schwab WC: Formalized radiology rounds: the final component of the tertiary survey. J Trauma 2004, 56:291-295.
• [23]Huynh TT, Blackburn AH, McMiddleton-Nyatui D, Moran KR, Thomason MH, Jacobs DG: An initiative by midlevel providers to conduct tertiary surveys at a level I trauma center. J Trauma 2010, 68:1052-1058.
• [24]Okello CR, Ezati IA, Gakwaya AM: Missed injuries: a Ugandan experience. Injury 2007, 38:112-117.
• [25]Howard J, Sundararajan R, Thomas SG, Walsh M, Sundararajan M: Reducing missed injuries at a level II trauma center. J Trauma Nurs 2006, 13:89-95.
• [26]Steel J, Youssef M, Pfeifer R, Ramirez JM, Probst C, Sellei R, Zelle BA, Sittaro NA, Khalifa F, Pape HC: Health-related quality of life in patients with multiple injuries and traumatic brain injury 10+ years postinjury. J Trauma 2010, 69:523-530. Discussion 530–1
• [27]McCarthy ML, MacKenzie EJ, Durbin DR, Aitken ME, Jaffe KM, Paidas CM, Slomine BS, Dorsch AM, Christensen JR, Ding R: Children’s health after trauma study group. Arch Pediatr Adolesc Med 2006, 160:252-260.