title: Missed injuries in the era of the trauma scan.
abstract: BACKGROUND
  A rapid computed tomography technique or "trauma scan" (TS) provides high-resolution studies of the head, cervical spine, chest, abdomen, and pelvis. We sought to determine whether TS has decreased missed injuries. A previous study of TS found a 3% missed rate.
  
  
  METHODS
  After institutional review board approval, trauma patients from January 2001 through December 2008 were reviewed for delayed diagnosis (DD) of injury to the head, cervical spine, chest, abdomen, or pelvis. Missed extremity injuries were excluded. Injury Severity Score, length of stay, type of injury, outcomes, and days to detection were captured.
  
  
  RESULTS
  Of 26,264 patients reviewed, 90 patients had DD, with an incidence of 0.34%. DD most commonly presented on day 2. Injuries included 16 bowel/mesentery, 12 spine, 11 pelvic, 8 spleen, 6 diaphragm, 5 clavicle, 4 scapula, 4 cervical spine, 4 intracranial, 4 sternum, 3 maxillofacial, 3 liver, 2 heart/aorta, 2 vascular, 2 urethra/bladder, 2 pneumothorax, and 2 pancreas/common bile duct. DD resulted in 1 death, 6 prolonged intensive care unit stays, 19 operative interventions, and 38 additional interventions.
  
  
  CONCLUSIONS
  TS is an effective way of evaluating trauma patients for intracranial, cervical spine, chest, abdomen, and pelvic injuries that have the potential to impact morbidity and mortality. The incidence of injuries missed in these crucial areas has been reduced at our institution by the use of this radiographic modality. The most common missed injury remains bowel, and so a high index of suspicion and the tertiary survey must remain a mainstay of therapy.
authors.affiliation: Department of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center, Knoxville, Tennessee 37920, USA. cmlawson@utmck.edu
authors.forename: Christy M
authors.initials: CM
authors.lastname: Lawson
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Daley
authors.forename: Christine B
authors.initials: CB
authors.lastname: Ormsby
authors.forename: Blaine
authors.initials: B
authors.lastname: Enderson
mesh_terms: D003365:Costs and Cost Analysis; D003951:Diagnostic Errors / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000191:economics