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Tertiary survey in polytrauma patients should be an ongoing process

Steven Ferree1, Roderick M Houwert2, Jacqueline J E M van Laarhoven1

  • 1Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Injury
|December 25, 2015
PubMed

Insights

Delayed diagnosed injuries (DDI) affect 12% of polytrauma patients, often involving extremities like hands and feet. High-energy trauma and initial extremity injuries increase DDI risk, necessitating repeated tertiary surveys.

Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Orthopedic Surgery

Background:

  • Prioritization in initial trauma care can lead to overlooked non-life-threatening injuries.
  • Polytrauma patients are particularly susceptible to delayed diagnosed injuries (DDI).
  • Limited research exists specifically on DDI in polytrauma populations.

Purpose of the Study:

  • To analyze the incidence and characteristics of DDI in polytrauma patients.
  • To identify independent risk factors associated with DDI in this patient group.

Main Methods:

  • Retrospective cohort study of adult polytrauma patients (Injury Severity Score ≥ 16) admitted between 2007-2012.
  • Hospital chart review to identify and categorize DDI.
  • Statistical analysis to determine risk factors for DDI.

Main Results:

  • 12% of 1416 polytrauma patients had DDI.
  • Most DDI (63%) were identified after the tertiary survey during initial hospital admission.
  • Extremity injuries, particularly hand and foot fractures, were the most common DDI (78%).
  • High-energy trauma, abdominal injury, and initial extremity injuries were independent risk factors for DDI.

Conclusions:

  • DDI are common in polytrauma patients, often diagnosed late in the hospital stay.
  • The tertiary survey process should be continuous and potentially repeated daily for polytrauma patients.
  • Extremity injuries, especially of the hand and foot, are the most frequent DDI.
Abstract

Keywords:
Delayed diagnosed injuriesPolytraumaTertiary survey

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