title: Missed injuries and unplanned readmissions in pediatric trauma patients.
abstract: BACKGROUND
  We sought to determine the incidence and characteristics of missed injuries and unplanned readmissions at a Level-1 pediatric trauma center.
  
  
  METHODS
  We conducted a retrospective review of all trauma patients who presented to our ACS-verified Level-1 pediatric trauma center from 2009 to 2014.
  
  
  RESULTS
  Overall, there were 27 readmissions and 27 missed injuries (0.38%). Patients who were unplanned readmissions had a greater Injury Severity Score (ISS) (8.6 vs 5.2, p=0.03), had longer hospitalizations (4.9 vs 2.5days, p=0.02), and were more likely to have required operative intervention (51.9% vs 32.3%, p=0.04). Similarly, patients identified with missed injuries had a higher ISS (15.2 vs 5.2, p<0.0001), greater length of stay (12.7 vs 2.5days, p<0.0001), and were also more likely to be intubated (25.9% vs 3.6%, p<0.0001) or require critical care (48.1% vs 10.3%, p<0.0001). Seven missed injuries were in patients who were deemed nonaccidental trauma (25.9%) and significantly altered their hospital course while 10 patients (37%) required operative intervention. On multivariate analysis, only ISS was found to be an independent risk factor for readmissions and missed injuries.
  
  
  CONCLUSIONS
  Missed injuries and unplanned readmissions were rare occurrences among our pediatric patient population. These events, however, did result in longer hospitalizations and additional procedures. Patients with multisystem injuries and compromised physical exam are at higher risk.
  
  
  METHODS
  IV.
authors.affiliation: Division of Pediatric Surgery, St. Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. Electronic address: choip@wustl.edu.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Choi
authors.affiliation: Division of Pediatric Surgery, St. Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yu
authors.affiliation: Division of Pediatric Surgery, St. Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D002648:Child; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008923:Missouri; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis*
keywords: Missed injuries; Pediatric trauma; Readmission