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Missed injuries in a rural area trauma center
R Robertson1, R Mattox, T Collins
1Department of Surgery, University of Arkansas for Medical Sciences, University Hospital of Arkansas, Little Rock 72205, USA.
Background:
Missed injuries can lead to delays. In the rural environment, where patients are frequently seen in multiple hospitals prior to reaching the trauma center, different problems arise.
Methods:
Level-1 trauma center admissions from January 1993 through June 1995 were reviewed. Missed injuries were those not identified within 24 hours of injury. Data extracted included demographics, mechanism, severity and outcome. Comparisons were made between missed injury patients and typical trauma patients.
Results:
Of 3,996 patients, 70 missed injuries were identified in 56 patients. Compared with typical trauma patients, missed injury patients suffered more blunt trauma, were more severely injured, had longer intensive care unit and hospital stays, and a lower mortality rate. Transferred patients accounted for 60% of missed injuries.
Conclusions:
Transferred patients with blunt injury have the highest risk for missed injury. Delayed transports and prior examination may contribute to complacency. All trauma patients must be repeatedly evaluated thoroughly, and all diagnostic studies reviewed for adequacy.