title: Ten-year retrospective study of delayed diagnosis of injury in pediatric trauma patients at a level II trauma center.
abstract: BACKGROUND
  Published rates of delayed diagnosis of injury (DDI) in pediatric trauma vary from 1.0% to 18%. The purpose of this study was to determine the long-term trend of DDI over 10 years, to identify risk factors associated with DDI, and to elucidate patterns of DDI.
  
  
  METHODS
  All patients aged 14 and younger who were admitted to Parkview Hospital for major trauma between January 1, 1997 and December 31, 2006 were included (1100 patients). Data were collected from a trauma registry that is maintained of all trauma admissions.
  
  
  RESULTS
  A total of 47 delayed diagnoses of injury were found in 44 patients for a rate of 4.0%. Patients with a DDI were more likely to have been intubated in the emergency department, transported by air, have an Injury Severity Score greater than 15, and have a Glasgow Coma Scale below 8 (P < 0.05). Mean intensive care unit and overall length of stay was longer in the DDI group. Missed injuries resulted in a change in therapy in 80% of cases. There were 5 missed intra-abdominal injuries, 4 of which required surgery. Three injuries were discovered upon outpatient follow-up. There was a trend for more missed upper extremity injuries in older patients and missed lower extremity injuries in younger patients.
  
  
  CONCLUSIONS
  The rate of missed injuries remained relatively constant over the past 10 years at our institution. More severely injured patients are more likely to have missed injuries. Special attention to the lower extremities of the younger trauma patient may be warranted.
authors.affiliation: Fort Wayne Medical Education Program, 10107 Lake Tahoe Ct., Fort Wayne, IN 46804, USA. bglawilliams@hotmail.com
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Williams
authors.forename: Thein
authors.initials: T
authors.lastname: Hlaing
authors.forename: Mary O
authors.initials: MO
authors.lastname: Aaland
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy; D015600:Glasgow Coma Scale; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis; D010343:Patient Admission; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy