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Published on: December 8, 2014
Delayed diagnosis in pediatric blunt trauma
J M Connors1, R M Ruddy, J McCall
1Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Insights
Delayed diagnosis in pediatric blunt trauma patients is linked to specific risk factors, including motor vehicle crashes and altered consciousness. Identifying these factors is crucial for improving patient outcomes and reducing adverse events.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Injury Epidemiology
Background:
- Timely injury identification is critical in emergency departments (EDs) and for trauma teams.
- Delayed diagnosis in trauma patients increases morbidity, mortality, and dissatisfaction.
- Understanding risk factors for delayed diagnosis in pediatric blunt trauma is essential.
Purpose of the Study:
- To compare children admitted for blunt trauma with and without delayed diagnosis.
- To identify risk factors associated with delayed diagnosis in pediatric trauma patients.
Main Methods:
- Prospective trauma registry data from 1991-1996 were used to identify delays.
- Retrospective chart review of patients with and without delayed diagnosis.
- Logistic regression analysis to determine predictors of delayed diagnosis.
Main Results:
- Sixty-five delays in diagnosis were identified in 58 patients (1% of all patients).
- Significant predictors of delay included female sex, motor vehicle crash (MVC) mechanism, altered consciousness, higher injury severity score, and multiple injuries.
- Patients with delayed diagnosis had greater trauma team activation, documented tertiary surveys, and longer hospitalizations.
Conclusions:
- Delayed diagnosis occurred in 1% of pediatric trauma patients.
- Trauma team care alone did not prevent all delays.
- Injury severity at presentation is insufficient to predict delayed diagnosis; a combination of factors is more predictive.
- Further research is needed to validate predictive criteria and assess the impact of earlier diagnosis on quality of care.
Objective:
Identification of injuries of a traumatized patient is a mandate for the emergency department (ED) and the trauma team. Delayed diagnosis of injury in trauma patients leads to increased morbidity, mortality, dissatisfaction, and risk of litigation. Comparing children admitted for blunt trauma, with and without delay, this study examines risk factors for delayed diagnosis.
Methods:
Delays in diagnosis from 1991 to 1996 were identified during prospective collection of trauma registry data. Controls were randomly selected from the trauma registry. Charts from both groups were retrospectively reviewed.
Results:
Fifty-eight patients had 65 delays in diagnosis. Significant independent delay variables included: female, motor vehicle crash (MVC)-related mechanism, altered consciousness, higher injury severity score, and multiple injuries (P < 0.05). Trauma team activation, documentation of tertiary survey, and length of hospitalization were greater in patients with delay injuries (P < 0.05). Logistic regression identified MVC-related mechanism, female, 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 earlier diagnosis would effect quality.
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