Missed injuries in trauma patients are a well recognised phenomenon. Currently at Gold Coast Hospital there is no formalized process for review of multi-trauma patients who are admitted to the general ward. Anecdotal evidence from the emergency department’s monthly trauma review meeting suggests that there are multiple factors that contribute to missed injuries. Commonly patients with an altered level of consciousness, those that are intoxicated or those that are unstable and require immediate operation, have injuries that may not be recognized in the ED. Also at risk are patients transferred from other facilities that have been assessed and managed elsewhere. The idea of a tertiary survey has been proposed as one strategy to reduce the incidence of missed injuries in trauma patients. This involves a re-evaluation within 24 hours of admission with a complete head to toe examination, review of laboratory results and radiologic studies. This is frequently documented on a tertiary survey form that is filed in the medical record.
Keijzers, G.B., Campbell, D., Hooper, J., Bost, N., Crilly, J., Steele, M.C., Eddington, B. and Geeraedts, L.M., 2011. Tertiary survey performance in a regional trauma hospital without a dedicated trauma service. World journal of surgery, 35(10), p.2341.dedicated trauma service. World journal of surgery, 35(10), pp.2341-2347.
Keijzers, G.B., Giannakopoulos, G.F., Del Mar, C., Bakker, F.C. and Geeraedts, L.M., 2012. The effect of tertiary surveys on missed injuries in trauma: a systematic review. Scandinavian journal of trauma, resuscitation and emergency medicine, 20(1), p.77.Resusc Emerg Med, 20, p.77.
Keijzers, G.B., Campbell, D., Hooper, J., Bost, N., Crilly, J., Steele, M.C., Del Mar, C. and Geeraedts Jr, L.M., 2014. A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey. World journal of surgery, 38(1), pp.222-232.
Keijzers, G.B., Del Mar, C., Geeraedts, L.M., Byrnes, J. and Beller, E.M., 2015. What is the effect of a formalised trauma tertiary survey procedure on missed injury rates in multi-trauma patients? Study protocol for a randomised controlled trial. Trials, 16(1), pp.1-8.
Prof Gerben Keijzers
Dr Don Campbell
Dr Don Pitchford
Dr Jeffrey Hooper
Prof Julia Crilly
Dr Christina Jennekens
Dr Marie Cooke