Role of an extended tertiary survey in detecting missed injuries in children
S V S Soundappan1, Andrew J A Holland, Daniel T Cass
1Children's Hospital at Westmead, Sydney, Australia.
Insights
Delayed diagnosis of pediatric injuries is common, with 16% of cases missed. An extended tertiary survey can help identify these injuries, especially in head trauma patients, reducing associated morbidity.
Area of Science:
- Pediatric Trauma Care
- Injury Diagnosis
- Medical Evaluation
Background:
- Limited data exists on the incidence of delayed injury diagnosis in children.
- Pediatric trauma patients often present complex diagnostic challenges.
Purpose of the Study:
- To investigate the effectiveness of an extended tertiary survey in identifying delayed diagnoses in pediatric trauma patients.
- To determine the incidence and characteristics of missed injuries in children.
Main Methods:
- A prospective study involving pediatric trauma patients with an Injury Severity Score (ISS) of 9 or higher.
- A tertiary survey was conducted by a trauma fellow the day after admission, with repeat assessments for ventilated or head-injured patients.
- Data collection focused on missed injuries, timing of diagnosis, and contributing factors.
Main Results:
- Sixteen percent (16%) of the 76 pediatric trauma patients experienced missed injuries, with skeletal injuries being most common.
- Delayed diagnosis occurred most frequently in motor vehicle accident victims, with inadequate assessment and head injury cited as primary factors.
- While missed injuries did not lead to mortality, they were associated with significant morbidity.
Conclusions:
- The incidence of missed injuries in pediatric trauma is comparable to adult populations.
- An extended tertiary survey is recommended for pediatric trauma evaluation to improve diagnostic accuracy.
- Ongoing evaluation is crucial for head-injured pediatric patients to mitigate risks associated with delayed diagnosis.
Background:
There are limited data on the incidence of delayed diagnosis of injuries in children. We sought to investigate the role of an extended tertiary survey in pediatric trauma patients.
Methods:
All children that were admitted to The Children's Hospital at Westmead with an Injury Severity Score (ISS) >/= 9 were included in the study. The trauma fellow performed the tertiary survey the day after admission. This was repeated after extubation in ventilated patients and in head injury patients when they were more mobile and cooperative.
Results:
Seventy-six patients satisfied the criteria for the study (50 boys and 26 girls). Age ranged from 1 month to 15 years. The median ISS was 14. Sixteen (16%) of the patients had missed injuries, of which skeletal injuries were the most common (10 of 12). Delayed diagnosis of injury occurred most frequently in children involved in motor vehicle injuries. Sixty-six (66%) of the injuries were detected within the first 24 hours. Inadequate assessment and head injury were the most common contributing factors.
Conclusion:
The incidence of missed injury (16%) in our study was comparable to reported figures in the adult literature. There was no correlation between missed injuries and intensive care unit stay or ISS. Head injury often delayed diagnosis and thus ongoing evaluation in this group is recommended. Missed injuries did not result in mortality, but there was significant associated morbidity. A tertiary survey should be part of the evaluation of the pediatric trauma patient.
