title: 23-Hour observation solely for identification of missed injuries after trauma: is it justified?
abstract: BACKGROUND
  The use of an observation period to identify missed injuries in trauma patients has gained favor in recent years. This study was undertaken in a population of patients with minimal or no identified injuries to determine the following: whether a period of in-patient observation identifies missed injuries; demographic factors associated with missed injuries; and morbidity of missed injuries.
  
  
  METHODS
  Over 4 years at a Level I trauma center, 4,738 patients were observed for 23 hours. Of these patients, 630 were converted to full admission and were reviewed. All medical records were reviewed for reason for observation, reason for conversion to full admission, and presence of missed injury.
  
  
  RESULTS
  In the 4,738 patients observed, 35 had a missed injury identified. No clinical factors studied were associated with identifying a missed injury. Of the 35 patients that had a missed injury, 21 did not have clinically relevant injuries, whereas the 14 remaining patients did. All of the 14 required prolonged hospital admissions and 9 underwent invasive procedures.
  
  
  CONCLUSIONS
  Of over 4,700 observed trauma patients, less than 0.5% remained hospitalized for significant missed injuries. No factors were identified that predicted missed injuries. Twenty-three-hour observation for the purpose of identifying missed injuries after thorough emergency department evaluation may not be justified.
authors.affiliation: Department of Surgery, Division of Burns, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas 75390, USA.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Stephan
authors.forename: M Clifann
authors.initials: MC
authors.lastname: McCarley
authors.forename: Grant E
authors.initials: GE
authors.lastname: O'Keefe
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
mesh_terms: D000328:Adult; D000465:Algorithms; D016009:Chi-Square Distribution; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014193:Trauma Centers / Q000458:organization & administration*