Initial managament in trauma involves resuscitation and detection of injuries. Despite efforts, some injuries are missed. A review of 432 adult blunt trauma patients demonstrated that 59 (13.6%) had 74 missed injuries. Missed injuries were those recognized during hospitalization but not identified during resuscitation. Most missed injuries were fractures (83.8%). Once detected, 40% required a change in therapy, including surgery. Twenty-eight percent were diagnosed after extubation or recovery of consciousness and 25% were never detected clinically. Radiologists diagnosed 28% of injuries by reviewing admission radiographs. Repeated physical examination, high suspicion and attention to complaints are essential in detecting missed injuries. (A)
Abstract