[Missed injuries in patients with multiple trauma: analysis of a trauma registry].
BACKGROUND
The frequency of missed injuries (MI) in patients with trauma oscillates between 0.5 and 38%, depending on the distinct studies and their inclusion criteria. In the present study, we evaluated the incidence, contributory factors and clinical relevance of these lesions, based on the Severe Trauma Registry of our center.


METHODS
We retrospectively analyzed a registry of 912 cases of severe trauma, which were prospectively gathered. Of these, 19 patients had a MI (2%). Demographic (age and sex) and clinical variables (severity scales and mechanism of injury) were compared and avoidable contributory factors and clinically relevant MI were evaluated.


RESULTS
Of the 19 patients with a MI, 58% had closed injuries. No statistically significant differences were found in any of the variables studied, although penetrating injuries were clearly more frequent in patients with MI than in those without. Forty-seven percent of MI were musculoskeletal, 26% were visceral and 21% were vascular. Sixty-three percent of contributory factors were potentially avoidable and the most frequent reason for MI was incorrect clinical evaluation. Mortality due to lesions with a delayed diagnosis was 21%.


CONCLUSIONS
Incorrect clinical evaluation was the avoidable factor that would have the greatest impact on reducing the number of MI. Another factor that clearly contributes to reduction of MI is appropriate interpretation of radiological images in the context of a tertiary survey. All teams treating these patients should periodically evaluate their results and intervene in the factors contributing to missed diagnoses.
Jiménez-Gómez
Luis Miguel
LM
Sección de Cirugía de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España. luismijg@hotmail.com
Amunategui
Iñaki
I
Sánchez
Juan María
JM
Colón
Arturo
A
Pérez
María Dolores
MD
Sanz
Mercedes
M
Turégano
Fernando
F
D000328:Adult; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis*; D012042:Registries; D012189:Retrospective Studies; D013030:Spain; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*; D014950:Wounds, Penetrating / Q000175:diagnosis*