title: Injuries missed during initial assessment of blunt trauma patients.
abstract: OBJECTIVE
  To determine the incidence and clinical significance of undiagnosed injuries in blunt trauma patients at our institution.
  
  
  METHODS
  Retrospective analysis of blunt trauma admissions over a 1-year period. Missed injury (MI) was defined as any injury recorded after the initial 24 hours.
  
  
  RESULTS
  Of 432 patients studied, 59 (13.6%) had MI. Fractures were the most common MI. Thirty-five percent of MI were detected during repeated physical examination and 28% after patients were conscious and able to voice concerns.
  
  
  CONCLUSIONS
  Over 10% of all blunt trauma patients had undiagnosed injuries. Forty percent of the MI had clinical implications. The most effective method of diagnosis consists of repeated clinical assessments. Special attention should be focused on patients with severe anatomical injuries, obtunded or intubated.
authors.affiliation: Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Canada.
authors.forename: S B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: B R
authors.initials: BR
authors.lastname: Boulanger
authors.forename: B A
authors.initials: BA
authors.lastname: McLellan
authors.forename: P W
authors.initials: PW
authors.lastname: Sharkey
mesh_terms: D000328:Adult; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology*