Missed injuries: a Ugandan experience.
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.
Okello
Caesar R
CR
Mulago Hospital, Kampala, Uganda. crokello@gmail.com
Ezati
I A
IA
Gakwaya
A M
AM
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