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The role of trauma team leaders in missed injuries: does specialty matter?
W Robert Leeper1, Terrence John Leeper, Kelly Nancy Vogt
1From the Department of Surgery (W.R.L., D.K.G., N.G.P.), Schulich School of Medicine and Dentistry (W.R.L., T.J.L., D.K.G., N.G.P.), University of Western Ontario; Trauma Program (T.C.-S., D.K.G., N.G.P.), and Division of Critical Care (W.R.L., N.G.P.), London Health Sciences Centre; and Centre for Critical Illness Research (N.G.P.), London, Ontario, Canada; and Division of Trauma and Critical Care (K.N.V.), Department of Surgery, University of Southern California, Los Angeles County Hospital, California.
Background:
Previous studies have identified missed injuries as a common and potentially preventable occurrence in trauma care. Several patient- and injury-related variables have been identified, which predict for missed injuries; however, differences in rate and severity of missed injuries between surgeon and nonsurgeon trauma team leaders (TTLs) have not previously been reported.
Methods:
A retrospective review was conducted on a random sample of 10% of all trauma patients (Injury Severity Score [ISS] > 12) from 1999 to 2009 at a Canadian Level I trauma center. Missed injuries were defined as those identified greater than 24 hours after presentation and were independently adjudicated by two reviewers. TTLs were identified as either surgeons or nonsurgeons.
Results:
Of our total trauma population of 2,956 patients, 300 charts were randomly pulled for detailed review. Missed injuries occurred in 46 patients (15%). Most common missed injuries were fractures (n = 32, 70%) and thoracic injuries (n = 23, 50%). The majority of missed injuries resulted in minor morbidity with only 5 (11%) requiring operative intervention. On univariate analysis, higher ISS (p < 0.01), higher maximum Abbreviated Injury Scale (MAIS) score of the thorax (p < 0.01), and nonsurgeon TTL status were predictive of missed injuries (p = 0.02). Multivariable logistic regression revealed that, after adjustment for age, ISS, and severe head injuries, the presence of a nonsurgeon TTL was associated with an increased odds of missed injury (odds ratio, 2.15; 95% confidence interval, 1.10-4.20).
Conclusion:
Missed injuries occurred in 15% of patients. A unique finding was the increased odds of missed injury with nonsurgeon TTLs. Further research should be undertaken to explore this relationship, elucidate potential causes, and propose interventions to narrow this discrepancy between TTL provider types.
Level Of Evidence:
Therapeutic study, level IV. Prognostic and epidemiologic study, level III.
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