title: Missed injury and the tertiary trauma survey.
abstract: Missed injury in the context of major trauma remains a persistent problem, both from a clinical and medico-legal point-of-view. Estimates of the incidence vary widely, dependent on the precise parameters of the studied population, the definition of missed injury and the extent of follow-up, but may be as high as 38%. The tertiary survey, in which formal repeated examination of the patient is undertaken after initial resuscitation and treatment have taken place, has been suggested as a way of identifying injuries not found at presentation. This paper appraises the concept of the tertiary survey, and also reviews the literature on missed injury in order to identify the risk factors, the types of injury and the reasons for error.
authors.affiliation: Academic Department of Emergency Medicine, University of Teesside, James Cook University Hospital, Marton Road, Middlesbrough, United Kingdom. ccbthomson@btinternet.com
authors.forename: Charles B
authors.initials: CB
authors.lastname: Thomson
authors.forename: Ian
authors.initials: I
authors.lastname: Greaves
mesh_terms: D003951:Diagnostic Errors; D004636:Emergency Service, Hospital / Q000592:standards*; D004812:Epidemiologic Methods; D006801:Humans; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D013997:Time Factors