MISSED INJURIES IN A RURAL AREA TRAUMA CENTER

BACKGROUND: Missed injuries can lead to delays. In the rural environme nt, where patients are frequently seen in multiple hospitals prior to reaching the trauma center, different problems arise. METHODS: Level-1 trauma center admissions from January 1993 through June 1995 were rev iewed. Missed injuries were those not identified within 24 hours of in jury. Data extracted included demographics, mechanism, severity and ou tcome. Comparisons were made between missed injury patients and typica l trauma patients. RESULTS: Of 3,996 patients, 70 missed injuries were identified in 56 patients. Compared with typical trauma patients, mis sed injury patients suffered more blunt trauma, were more severely inj ured, had longer intensive care unit and hospital stays, and a lower m ortality rate. Transferred patients accounted for 60% of missed injuri es. CONCLUSIONS: Transferred patients with blunt injury have the highe st risk for missed injury. Delayed transports and prior examination ma y contribute to complacency. All trauma patients must be repeatedly ev aluated thoroughly, and all diagnostic studies reviewed for adequacy. (C) 1996 by Excerpta Medica, Inc.