PROSPECTIVE EVALUATION OF EARLY MISSED INJURIES AND THE ROLE OF TERTIARY TRAUMA SURVEY

Background: This study prospectively evaluated the prevalence, clinica l significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant mi ssed injury, tertiary survey, and contributing factors were defined. T ertiary survey was conducted within 24 hours. Results: Of 206 patients , 134 patients (65%) had 309 missed injuries composing 39% of all 798 injuries seen, Tertiary trauma survey detected 56% of early missed inj uries and 90% of clinically significant missed injuries within 24 hour s, Clinically significant missed injuries occurred in 30 patients with complications in 11 patients and death in two patients. Of 224 contri buting errors, 123 errors were in clinical assessment, 83 errors were in radiology, 14 errors were patient related, and four errors were tec hnical, The missed injury rate was significantly higher in patients wi th multiple injuries and in those involved in road crashes. Conclusion s: Secondary trauma survey is not a definitive assessment and should b e supplemented by tertiary trauma survey.