Tertiary Trauma Survey: Evaluation of Missed Injuries at a Teaching Hospital in the Developing World.

Background: The gold standard in the care of the multiply injured is the prompt identification of all life-threatening and associated injuries by using the Advanced Trauma Life Support protocol (ATLS). The main objective of this study was to determine the incidence of missed injuries in patients presenting to our hospital and to identify the primary contributing factors for each missed injury.
Methods: An initial evaluation of our trauma registry data for missed injuries in a 90% population of trauma victims yielded an incidence of 12%. However, to determine the true incidence of missed injuries, a prospective tertiary trauma survey was performed on all injured patients admitted during a six month period. After the primary and secondary surveys, all injuries and treatments were documented in the patients’ trauma medical records. They were then re-examined immediately by the senior orthopaedic registrars and subsequently by the investigator.
Results: Fifty-two missed injuries were found in 46 patients (10.5%) out of 438 cases. Reasons for missed injuries include haemodynamic in stability 3 (0.7%), head injury 17 (3.9%), low index of suspicion 5 (1.1%), lack of symptoms 6 (1.4%) and technical problems 12 (2.7%).
Conclusion: There is a need to re-appraise our trauma care practice to reduce the incidence of missed injuries.