CAUSES AND PATTERNS OF MISSED INJURIES IN TRAUMA

Missed injuries have a bad reputation and are sometimes associated wit h serious morbidity for the patient and personal embarrassment for the surgeon. During a 10-year period, 123 missed injuries in 117 patients requiring re-operation were encountered in one trauma center. A retro spective review of causes and patterns was undertaken. The most common presentation was delayed hemorrhage (64 injuries). The colon, thoraci c vasculature, chest wall arteries, and diaphragm were the most freque ntly involved sites. Forty-six injuries were overlooked during the dia gnostic work-up, and 43 were missed during surgery. Technical problems with diagnosis and surgery accounted for 62% of missed injuries, wher eas decision and judgment errors accounted for the rest. Further insig ht was provided by the classification of missed injuries into three ty pes. Type I (20%) occurred outside the body area of clinical focus, wh ereas type II (69%) occurred within it. Type III (11%) resulted when i nstability of the patient necessitated interruption of the diagnostic work-up or exploration. Each type represents a different clinical patt ern and dictates a specific preventive strategy.