Significant reduction in delayed diagnosis of injury with implementation of a pediatric trauma service.
BACKGROUND
The occurrence of delayed diagnosis of injury (DDI) among pediatric trauma patients represents a breakdown in trauma care. Although some DDI may be unavoidable, the rate of DDI may be used as a measure of quality improvement.


OBJECTIVE
We sought to investigate DDI in admitted pediatric trauma patients while a designated pediatric trauma response team was used and compare this with the prior incidence of DDI (4.3%) before initiation of the response team.


METHODS
Primary Children's Medical Center (PCMC) is a regional tertiary pediatric trauma center. This analysis used the prospectively gathered PCMC Trauma Database, and included all hospitalized pediatric trauma patients from 1997 through 2000.


RESULTS
A total of 3265 patients were included; no patients were excluded. A DDI occurred in 15 (0.46%; 95% CI: 0.31, 0.79) trauma patients. The DDI patients were more severely injured with significantly higher Injury Severity Scores, lower TRISS Probability of Survival values, longer hospitalizations (P < or = 0.05, Mann-Whitney U), and were more frequently admitted to the PICU (P < or = 0.05, chi2) than the non-DDI patient population. In a previous study, our incidence of missed injury was 4.3% (50/1175; 95% CI: 3.3, 5.6); with implementation of a designated trauma response team and trauma service, the incidence of DDI was reduced nearly 10-fold to 0.46% (15/3265; 95% CI: 0.31, 0.79).


CONCLUSIONS
Implementation of an effective trauma team and trauma service was associated with a significant reduction in DDI.
Perno
Joseph F
JF
Division of Pediatric Emergency Medicine, Department of Pediatrics, All Children's Hospital, St. Petersburg, FL, USA. jperno@pol.net
Schunk
Jeff E
JE
Hansen
Kristine W
KW
Furnival
Ronald A
RA
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics / Q000458:organization & administration* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D016019:Survival Analysis; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014589:Utah / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology