title: Missed injuries: a Ugandan experience.
abstract: BACKGROUND
  Missed injuries (MIs) have been noted worldwide in all trauma centres that have studied them, and they are a significant cause of patient morbidity and mortality.
  
  
  OBJECTIVE
  To establish the prevalence, contributing factors and short-term outcome of missed injuries in cases of multiple and major trauma.
  
  
  METHODS
  Longitudinal prospective study involving 403 patients over 5 months.
  
  
  RESULTS
  Missed injuries were discovered in 78 cases (prevalence 19.4%). Contributing factors included incomplete assessment (52.5%), radiological errors, surgical failures and patient's arrival time. The most affected body regions were the head and neck, extremities and pelvic girdle and contents; in the abdomen, 49.1% of injuries were missed. Among the 28 deaths in the study, 21 occurred in cases with missed injuries, and 13 (62%) of these deaths were directly attributable to missed injuries (R2=12.5, p=0.0001, 95% CI 5.5-28.35).
  
  
  CONCLUSIONS
  There is need for improvement in patient assessment and monitoring, in efficiency of the trauma team, and for staff redistribution to address the increase in night arrivals.
authors.affiliation: Mulago Hospital, Kampala, Uganda. crokello@gmail.com
authors.forename: Caesar R
authors.initials: CR
authors.lastname: Okello
authors.forename: I A
authors.initials: IA
authors.lastname: Ezati
authors.forename: A M
authors.initials: AM
authors.lastname: Gakwaya
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D009104:Multiple Trauma / Q000175:diagnosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology