Delayed diagnosis in pediatric blunt trauma

Objective: Identification of injuries of a traumatized patient is a mandate for the emergency department (ED) and the trauma team. Delayed diagnosis o f injury in trauma patients leads to increased morbidity, mortality, dissat isfaction, and risk of Litigation. Comparing children admitted for blunt tr auma, with and without delay, this study examines risk factors for delayed diagnosis, Methods: Delays in diagnosis from 1991 to 1996 were identified during prosp ective collection of trauma registry data. Controls were randomly selected from the trauma registry, Charts from both groups were retrospectively revi ewed. Results: Fifty-eight patients had 65 delays in diagnosis. Significant indep endent delay variables included: female, motor vehicle crash (MVC)-related mechanism, altered consciousness, higher injury severity score, and multipl e injuries (P < 0.05). Trauma team activation, documentation of tertiary su rvey, and length of hospitalization were greater in patients with delay inj uries (P < 0.05). Logistic regression identified MVC-related mechanism, fem ale, facial, and extremity injuries as a combination of predictors. Conclusions: Delays occurred in 1% of patients. Trauma team care itself did not protect all patients from delay. Injury severity at presentation alone is not an adequate predictor of delayed diagnosis in the pediatric patient . A combination of variables was identified as negative predictors of delay , Further study is needed to validate these criteria, and determine if earl ier diagnosis would effect quality.