Influencing factors for delayed diagnosed injuries in multiple trauma patients - introducing the 'Risk for Delayed...

Area of Science:

• Trauma surgery
• Emergency medicine
• Injury detection

Background:

• Delayed diagnosed injuries (DDIs) present a significant challenge in managing severely injured patients.
• Effective identification of DDIs is crucial for optimizing patient outcomes and resource allocation in trauma care.

Purpose of the Study:

• To determine the incidence and types of DDIs in a large trauma cohort.
• To identify factors predicting DDIs.
• To develop a risk score for identifying patients susceptible to DDIs.

Main Methods:

• Analysis of multiply injured patients from the TraumaRegister DGU® (2011-2020).
• Inclusion criteria: severe injuries and/or intensive care admission, survival >24 hours.
• Multivariate logistic regression to identify risk factors and develop the 'Risk for Delayed Diagnoses' (RIDD) score.

Main Results:

• 9.2% of 99,754 patients (9,175) had 13,226 DDIs, most commonly head, extremity, and thoracic injuries.
• Patients with DDIs exhibited higher ISS, more frequent unconsciousness/shock, increased blood transfusion needs, and longer ICU/hospital stays.
• Seven risk factors were identified (OR 1.2-1.9), forming the RIDD score, with DDI risk ranging from 3.6% to 24.8%.

Conclusions:

• DDIs are prevalent in trauma patients, underscoring the need for vigilant physical examination.
• The RIDD score aids in identifying high-risk patients for DDIs.
• Implementing a tertiary survey is recommended to minimize missed or delayed diagnoses.