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. 2022 Feb;48(1):423-429.
doi: 10.1007/s00068-020-01473-3. Epub 2020 Sep 5.

The yield of tertiary survey in patients admitted for observation after trauma

Gijs Jacob Jan van Aert  1 , Jelle Corneel van Dongen  2 , Niels Cornelis Adrianus Sebastianus Berende  3 , Hendrikus Gerardus Wilhelmus de Groot  3 , Pieter Boele van Hensbroek  3 , Philip Marcel Jozef Schormans  3 , Dagmar Isabella Vos  3
Affiliations

The yield of tertiary survey in patients admitted for observation after trauma

Gijs Jacob Jan van Aert et al. Eur J Trauma Emerg Surg. 2022 Feb.

Abstract

Purpose: Existing literature on trauma tertiary survey (TTS) focusses on multitrauma patients. This study examines the yield of the TTS in trauma patients with minor (AIS 1) or moderate (AIS 2) injury for which immediate hospitalization is not strictly indicated.

Method: A single center retrospective cohort study was performed in a level II trauma center. All hospitalized trauma patients with an abbreviate injury score (AIS) of one or two at the primary and secondary survey were included. The primary outcome was defined as any missed injury found during TTS (Type 1). Secondary outcomes were defined as any missed injury found after TTS but during admission (Type 2); overall missed injury rate; mortality and hospital length of stay.

Results: Out of 388 included patients, 12 patients (3.1%) had a type 1 missed injury. ISS and alcohol consumption were associated with an increased risk for type 1 missed injuries (resp. OR = 1.4, OR = 5.49). A type 2 missed injury was only found in one patient. This concerned the only case of trauma related mortality. Approximately one out of five patients were admitted for more than 2 days. These patients were significantly older (66 vs. 41 years, p < 0.001), had a higher ISS (4 vs. 3, p = 0.007) and ASA score, 3-4 vs. 1-2 (42.5% vs. 12.6%, p < 0.001).

Conclusion: TTS showed a low rate of missed injuries in trauma patients with minor or moderate injury. TTS helped to prevent serious damage in two out of 388 patients (0.5%). ISS and alcohol consumption were associated with finding missed injury during TTS.

Keywords: Missed injury; Patient safety; Quality of care; Tertiary survey; Trauma.

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References

    1. Brasel KJ. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–6. https://doi.org/10.1097/TA.0b013e31828b82f5 . - DOI
    1. Keijzers GB, Giannakopoulos GF, Del Mar C, Bakker FC, Geeraedts LMG. The effect of tertiary surveys on missed injuries in trauma: a systematic review. Scand J Trauma Resusc Emerg Med. 2012;20:1–9. https://doi.org/10.1186/1757-7241-20-77 . - DOI
    1. Thomson CB, Greaves I. Missed injury and the tertiary trauma survey. Injury. 2008;39(1):107–14. https://doi.org/10.1016/j.injury.2007.07.030 . - DOI - PubMed - PMC
    1. Enderson BL, Reath DB, Meadors J, Dallas W, Deboo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma Inj Infect Crit Care. 1990;30(6):666–70. https://doi.org/10.1097/00005373-199006000-00002 . - DOI
    1. Zamboni C, Yonamine AM, Faria CEN, Filho MAM, Christian RW, Mercadante MT. Tertiary survey in trauma patients: avoiding neglected injuries. Injury. 2014;45(S5):S14–S1717. https://doi.org/10.1016/S0020-1383(14)70014-2 . - DOI - PubMed - PMC

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