title: Association of head, thoracic and abdominal trauma with delayed diagnosis of co-existing injuries in critical trauma patients.
abstract: BACKGROUND
  Management of critically injured patients is usually complicated and challenging. A structured team approach with comprehensive survey is warranted. However, delayed diagnosis of co-existing injuries that are less severe or occult might still occur, despite a standard thorough approach coupled with advances in image intervention. Clinicians are easily distracted or occupied by the more obvious or threatening conditions. We hypothesised that the major area of injured body regions might contribute to this unwanted condition.
  
  
  METHODS
  A retrospective study of all trauma patients admitted to our surgical intensive care units (ICU) was performed to survey the incidence of delayed diagnosis of injury (DDI) and the association between main body region injured and possibility of DDI. Demographic data and main body regions injured were compared and statistically analysed between patients with and without DDI.
  
  
  RESULTS
  During the two-year study period, a total 976 trauma patients admitted to our surgical ICU were included in this study. The incidence of DDI was 12.1% (118/976). Patients with DDI had higher percentages of thoracic, abdominal, and pelvic injuries (30.5%, 16.1%, and 7.6% respectively) than the non-DDI group (14.7%, 7.5%, and 3.0% respectively) (p<0.001, 0.003, and 0.024 respectively). A logistic regression model demonstrated that head (odds ratio=1.99; 95%CI=1.20-3.31), thoracic (odds ratio=2.44; 95%CI=1.55-3.86), and abdominal injuries (odds ratio=2.38; 95%CI=1.28-4.42) were independently associated with increasing DDI in patients admitted to the surgical ICU.
  
  
  CONCLUSIONS
  In conclusion, critical trauma patients admitted to the surgical ICU with these categories of injuries were more likely to have DDI. Clinicians should pay more attention to patients admitted due to injuries in these regions. More detailed and dedicated secondary and tertiary surveys should be given, with more frequent and careful re-evaluation.
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Fellow of International College of Surgeons, Taiwan Section. Electronic address: p620822@yahoo.com.tw.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Lee
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: ytljwc@yahoo.com.tw.
authors.forename: Chao-Wen
authors.initials: CW
authors.lastname: Chen
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: yenko@ms16.hinet.net.
authors.forename: Yen-Ko
authors.initials: YK
authors.lastname: Lin
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: cybersphinx@msn.com.
authors.forename: Tsung-Ying
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: lckaku@yahoo.com.tw.
authors.forename: Liang-Chi
authors.initials: LC
authors.lastname: Kuo
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 960090@ms.kmuh.org.tw.
authors.forename: Yuan-Chia
authors.initials: YC
authors.lastname: Cheng
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: sookm67@hotmail.com.
authors.forename: Kwan-Ming
authors.initials: KM
authors.lastname: Soo
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Fellow of International College of Surgeons, Taiwan Section. Electronic address: hsinglin2002@yahoo.com.tw.
authors.forename: Hsing-Lin
authors.initials: HL
authors.lastname: Lin
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003657:Decision Making; D057210:Delayed Diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*
keywords: Abdominal injury; Critical care; Delayed diagnosis of injury; Emergency medicine; Head injury; Thoracic injury; Trauma