title: Prospective evaluation of early missed injuries and the role of tertiary trauma survey.
abstract: BACKGROUND
  This study prospectively evaluated the prevalence, clinical significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant missed injury, tertiary survey, and contributing factors were defined. Tertiary survey was conducted within 24 hours.
  
  
  RESULTS
  Of 206 patients, 134 patients (65%) had 309 missed injuries composing 39% of all 798 injuries seen. Tertiary trauma survey detected 56% of early missed injuries and 90% of clinically significant missed injuries within 24 hours. Clinically significant missed injuries occurred in 30 patients with complications in 11 patients and death in two patients. Of 224 contributing errors, 123 errors were in clinical assessment, 83 errors were in radiology, 14 errors were patient related, and four errors were technical. The missed injury rate was significantly higher in patients with multiple injuries and in those involved in road crashes.
  
  
  CONCLUSIONS
  Secondary trauma survey is not a definitive assessment and should be supplemented by tertiary trauma survey.
authors.affiliation: Liverpool Hospital, New South Wales, Australia.
authors.forename: K J
authors.initials: KJ
authors.lastname: Janjua
authors.forename: M
authors.initials: M
authors.lastname: Sugrue
authors.forename: S A
authors.initials: SA
authors.lastname: Deane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D019300:Medical Errors; D008875:Middle Aged; D009517:New South Wales; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging