TY - JOUR
T1 - Delayed diagnosed injuries in trauma patients after initial trauma assessment with a total-body computed tomography scan
AU - Kok, D.
AU - Oud, S.
AU - Giannakópoulos, G. F.
AU - Scheerder, M. J.
AU - Beenen, L. F. M.
AU - Halm, J. A.
AU - Treskes, K.
N1 - Funding Information: We would like to thank the Network of Acute Care Northwest Netherlands/ Flevoland (NAZNH-FL), Amsterdam, The Netherlands for providing a major part of the data collection. Publisher Copyright: © 2023 The Author(s)
PY - 2024
Y1 - 2024
N2 - Introduction: Even when using the Advanced Trauma Life Support (ATLS) guidelines and other diagnostic protocols for the initial assessment of trauma patients, not all injuries will be diagnosed in this early stage of care. The aim of this study was to quantify how many, and assess which type of injuries were diagnosed with delay during the initial assessment of trauma patients including a total-body computed tomography (TBCT) scan in a Level 1 Trauma Center in the Netherlands. Methods: We conducted a retrospective cohort study of 697 trauma patients who were assessed in the trauma bay of the Amsterdam University Medical Center (AUMC), using a TBCT. A delayed diagnosed injury was defined as an injury sustained during the initial trauma and not discovered nor suspected upon admission to the Intensive Care Unit (ICU) or surgical ward following the initial assessment, diagnostic studies, or during immediate surgery. A clinically significant delayed diagnosis of injury was defined as an injury requiring follow-up or further medical treatment. We aimed to identify variables associated with delayed diagnosed injuries. Results: In total, 697 trauma patients with a median age of 46 years (IQR 30–61) and a median Injury Severity Score (ISS) of 16 (IQR 9–25) were included. Delayed diagnosed injuries were found in 97 patients (13.9 %), of whom 79 injuries were clinically significant (81.4 %). Forty-eight of the delayed diagnosed injuries (49.5 %) were within the TBCT field. Ten delayed diagnosed injuries had an Abbreviated Injury Scale (AIS) of ≥3. Most injuries were diagnosed before or during the tertiary survey (60.8 %). The median time of delay was 34.5 h (IQR 17.5–157.3). Variables associated with delayed diagnosed injuries were primary ICU admission (OR 1.8, p = 0.014), an ISS ≥ 16 (OR 1.6, p = 0.042), and prolonged hospitalization (40+ days) (OR 8.5, p < 0.001). Conclusion: With the inclusion of the TBCT during the primary assessment of trauma patients, delayed diagnosed injuries still occurs in a significant number of patients (13.9 %). Factors associated with delayed diagnosed injuries were direct admission to ICU and an ISS ≥ 16.
AB - Introduction: Even when using the Advanced Trauma Life Support (ATLS) guidelines and other diagnostic protocols for the initial assessment of trauma patients, not all injuries will be diagnosed in this early stage of care. The aim of this study was to quantify how many, and assess which type of injuries were diagnosed with delay during the initial assessment of trauma patients including a total-body computed tomography (TBCT) scan in a Level 1 Trauma Center in the Netherlands. Methods: We conducted a retrospective cohort study of 697 trauma patients who were assessed in the trauma bay of the Amsterdam University Medical Center (AUMC), using a TBCT. A delayed diagnosed injury was defined as an injury sustained during the initial trauma and not discovered nor suspected upon admission to the Intensive Care Unit (ICU) or surgical ward following the initial assessment, diagnostic studies, or during immediate surgery. A clinically significant delayed diagnosis of injury was defined as an injury requiring follow-up or further medical treatment. We aimed to identify variables associated with delayed diagnosed injuries. Results: In total, 697 trauma patients with a median age of 46 years (IQR 30–61) and a median Injury Severity Score (ISS) of 16 (IQR 9–25) were included. Delayed diagnosed injuries were found in 97 patients (13.9 %), of whom 79 injuries were clinically significant (81.4 %). Forty-eight of the delayed diagnosed injuries (49.5 %) were within the TBCT field. Ten delayed diagnosed injuries had an Abbreviated Injury Scale (AIS) of ≥3. Most injuries were diagnosed before or during the tertiary survey (60.8 %). The median time of delay was 34.5 h (IQR 17.5–157.3). Variables associated with delayed diagnosed injuries were primary ICU admission (OR 1.8, p = 0.014), an ISS ≥ 16 (OR 1.6, p = 0.042), and prolonged hospitalization (40+ days) (OR 8.5, p < 0.001). Conclusion: With the inclusion of the TBCT during the primary assessment of trauma patients, delayed diagnosed injuries still occurs in a significant number of patients (13.9 %). Factors associated with delayed diagnosed injuries were direct admission to ICU and an ISS ≥ 16.
KW - Delayed diagnosed injuries
KW - Missed injuries
KW - TBCT
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85181829874&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.injury.2023.111304
DO - https://doi.org/10.1016/j.injury.2023.111304
M3 - Article
C2 - 38171970
SN - 0020-1383
VL - 55
JO - Injury
JF - Injury
IS - 5
M1 - 111304
ER -