title: Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures.
abstract: BACKGROUND
  This article describes the characteristics of missed lower urologic injuries at a level 1 trauma center using advanced trauma life support protocols. Between 1991 and 1996, 635 patients were treated for traumatic pelvic fractures. For the 43 patients with missed urologic diagnoses, the pelvic fracture pattern, initial evaluation, average delay to diagnosis and treatment, reason for the delay, and manner in which the lower urinary tract injury was discovered and treated were identified.
  
  
  RESULTS
  Of 43 patients with pelvic fracture, 10 (23%) with concomitant urologic injury had initially missed diagnoses. Delay in diagnosis and treatment averaged 19 hours for missed intraperitoneal bladder ruptures and 6.7 days for missed extraperitoneal bladder ruptures.
  
  
  CONCLUSIONS
  The findings show that 23% of all bladder and urethral disruptions associated with pelvic fractures were missed at initial evaluation. The pelvic fracture pattern, in addition to physical examination, should direct the urologic evaluation for trauma patients.
authors.affiliation: St. Elizabeth Health Center, Youngstown, Ohio, USA. bruce_ziran@hmis.org
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Ziran
authors.forename: Eric
authors.initials: E
authors.lastname: Chamberlin
authors.forename: Franklin D
authors.initials: FD
authors.lastname: Shuler
authors.forename: Munir
authors.initials: M
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D003558:Cystoscopy; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D050723:Fractures, Bone / Q000145:classification / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D009820:Ohio / Q000453:epidemiology; D010384:Pelvic Bones / Q000293:injuries*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012421:Rupture; D013997:Time Factors; D014521:Urethra / Q000293:injuries; D001743:Urinary Bladder / Q000293:injuries; D014546:Urinary Catheterization; D014551:Urinary Tract / Q000293:injuries*; D014567:Urography