title: Tertiary survey performance in a regional trauma hospital without a dedicated trauma service.
abstract: BACKGROUND
  Initial management of trauma patients is focused on identifying life- and limb-threatening injuries and may lead to missed injuries. A tertiary survey can minimise the number and effect of missed injuries and involves a physical re-examination and review of all investigations within 24 h of admission. There is little information on current practice of tertiary survey performance in hospitals without a dedicated trauma service. We aimed to determine the rate of tertiary survey performance and the detail of documentation as well as the baseline rate of missed injuries.
  
  
  METHODS
  We performed a retrospective, descriptive study of all multitrauma patients who presented to an Australian level II regional trauma centre without a dedicated trauma service between May 2008 and February 2009. A medical records review was conducted to determine tertiary survey performance and missed injury rate.
  
  
  RESULTS
  Of 252 included trauma patients, 20% (n = 51) had a tertiary survey performed. A total of nine missed injuries were detected in eight patients (3.2%). Of the multiple components of the tertiary survey, most were poorly documented. Documentation was more comprehensive in the subgroup of patients who did have a formal tertiary survey.
  
  
  CONCLUSIONS
  Tertiary survey performance was poor, as indicated by low documentation rates. The baseline missed injury rate was comparable to previous that of retrospective studies, although in this study an underestimation of true missed injury rates is likely. Implementing a formal, institutional tertiary survey may lead to improved tertiary survey performance and documentation and therefore improved trauma care in hospitals without a dedicated trauma service.
authors.affiliation: Emergency Department, Gold Coast Health Service District, Gold Coast, QLD, Australia. gerben_keijzers@health.qld.gov.au
authors.forename: Gerben B
authors.initials: GB
authors.lastname: Keijzers
authors.forename: Don
authors.initials: D
authors.lastname: Campbell
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hooper
authors.forename: Nerolie
authors.initials: N
authors.lastname: Bost
authors.forename: Julia
authors.initials: J
authors.lastname: Crilly
authors.forename: Michael Craig
authors.initials: MC
authors.lastname: Steele
authors.forename: Blake
authors.initials: B
authors.lastname: Eddington
authors.forename: Leo M G
authors.initials: LM
authors.lastname: Geeraedts
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000628:therapy; D011787:Quality of Health Care; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards*