Delayed diagnosis of injury in pediatric trauma
R A Furnival1, G A Woodward, J E Schunk
1Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City 84113, USA.
Insights
Delayed diagnosis of injury (DDI) occurred in 4.3% of pediatric trauma patients, particularly those severely injured. Ongoing evaluation is crucial to identify unrecognized injuries in all pediatric trauma cases.
Area of Science:
- Pediatric Trauma Care
- Injury Diagnosis
- Medical Record Review
Background:
- Delayed diagnosis of injury (DDI) is a critical issue in pediatric trauma care.
- Understanding the frequency and characteristics of DDI is essential for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and nature of delayed diagnosis of injury (DDI) in pediatric trauma.
- To identify risk factors and consequences associated with DDI in children.
Main Methods:
- Retrospective review of medical records.
- Study conducted at a tertiary pediatric trauma center.
- Involved 1175 pediatric trauma admissions over a three-year period.
Main Results:
- Fifty patients (4.3%) experienced 53 DDIs, with fractures being the most common type.
- Patients with DDI had more severe injuries, longer intensive care unit and hospital stays, and required more interventions.
- Delayed diagnosis altered treatment for 68% of affected patients, necessitating additional surgeries in some cases.
Conclusions:
- Delayed diagnosis of injury (DDI) signifies a breakdown in pediatric trauma care.
- Severely injured children are at higher risk for DDI.
- Continuous evaluation of all pediatric trauma patients is necessary to detect missed injuries.
Objective:
To define the frequency and nature of delayed diagnosis of injury (DDI) in pediatric trauma.
Design:
Retrospective review.
Setting:
Tertiary pediatric trauma center.
Methods:
Medical records of 1175 pediatric trauma admissions from July 1, 1989, through June 30, 1992, were reviewed.
Results:
Fifty (4.3%) patients had 53 DDI. Fractures accounted for 38 DDI, most commonly of the extremities (total, 16). The delay until injury diagnosis ranged from 1 to 55 (median, 3) days. Patients with DDI had lower scores on the Glasgow Coma Scale, higher injury severity scores, and longer pediatric intensive care unit and hospital stays than patients without DDI. Patients with DDI more frequently required medical transport, emergent intubation, admission to the pediatric intensive care unit, and surgery. The DDI altered treatment for 68% of patients; 10 required surgery, including second operations for 6 children.
Conclusions:
DDI represents a failure of pediatric trauma care at all levels. The severely injured child is at the greatest risk of DDI. All pediatric patients with trauma warrant ongoing evaluation to identify initially unrecognized injuries.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:28Traumatic Brain Injury l: Introduction
01:25Secondary Spinal Cord Injury llI: Pathophysiology