Missed injuries in patients with multiple trauma

Background: Understanding the etiology of missed injuries is essential in m inimizing its occurrence. A retrospective review was conducted to identify the incidence, contributing factors, and clinical outcomes of missed injuri es. Methods: All trauma patients assessed by St Michael's Hospital trauma servi ce from April 1, 1995, to July 31, 1997, were included in the study. Demogr aphic and medical data were compared and statistically analyzed in two pati ent groups to identify factors associated with missed injuries. Results: Forty six of 567 patients (8.1%) had missed injuries. Patients wit h missed injuries had higher mean Injury Severity Scores and longer stays i n the hospital and intensive care unit compared with patients without misse d injuries (p < 0.05). Patients with missed injuries were more likely to ha ve lower Glasgow Coma Scale scores and to have required pharmacologic paral ysis (p < 0.05). Of the factors contributing to missed injuries, 56.3% were potentially avoidable and 43.8% were unavoidable. Seven patients with miss ed injuries had clinically significant outcomes, including one patient deat h. Of the seven clinically significant missed injuries, five were attributa ble to potentially avoidable factors. Conclusion: Patients with missed injuries tend to be more severely injured with initial neurologic compromise. The majority of missed injuries are pot entially avoidable with repeat clinical assessments and a high index of sus picion.