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Related Experiment Videos

Missed injuries. The trauma surgeon's nemesis.

B L Enderson1, K I Maull

  • 1Division of Trauma/Critical Care, University of Tennessee Medical Center, Knoxville.

The Surgical Clinics of North America
|April 1, 1991
PubMed
Summary

Diagnosing all injuries in multiply injured trauma patients is challenging. A systematic approach, including tertiary surveys, helps detect missed injuries, improving patient outcomes.

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Multiply injured patients present complex diagnostic and therapeutic challenges.
  • Factors like altered consciousness, hemodynamic instability, and diagnostic oversight can lead to missed injuries.
  • Injuries can be overlooked at any stage of patient management, including intraoperatively.

Purpose of the Study:

  • To highlight the challenge of diagnosing all injuries in multiply injured trauma patients.
  • To emphasize the importance of systematic evaluation protocols to minimize missed injuries.
  • To advocate for a proactive and humble approach to identify overlooked injuries.

Main Methods:

  • Review of established trauma management protocols, including primary, secondary, and tertiary surveys.
  • Emphasis on careful intraoperative examination, especially in hemodynamically unstable patients.
  • Recommendation for a tertiary survey as a re-examination tool for detecting missed injuries.

Main Results:

  • Established protocols like Advanced Trauma Life Support (ATLS) primary and secondary surveys reduce the likelihood of missing immediately life-threatening injuries.
  • A meticulous intraoperative approach is crucial for identifying all injuries, not just those initially apparent.
  • Tertiary surveys are effective in detecting injuries missed during initial evaluations.

Conclusions:

  • Missed injuries are an inherent risk in managing multiply injured patients.
  • A systematic and vigilant approach, incorporating tertiary surveys, is essential for early detection.
  • Humility and alertness in searching for diagnostic oversights minimize consequences of missed injuries.

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