Missed injuries in trauma patients: A literature review

<p>Abstract</p> <p>Background</p> <p>Overlooked injuries and delayed diagnoses are still common problems in the treatment of polytrauma patients. Therefore, ongoing documentation describing the incidence rates of missed injuries, clinically significant missed injuries, contributing factors and outcome is necessary to improve the quality of trauma care. This review summarizes the available literature on missed injuries, focusing on overlooked muscoloskeletal injuries.</p> <p>Methods</p> <p>Manuscripts dealing with missed injuries after trauma were reviewed. The following search modules were selected in PubMed: Missed injuries, Delayed diagnoses, Trauma, Musculoskeletal injuires. Three time periods were differentiated: (n = 2, 1980–1990), (n = 6, 1990–2000), and (n = 9, 2000-Present).</p> <p>Results</p> <p>We found a wide spread distribution of missed injuries and delayed diagnoses incidence rates (1.3% to 39%). Approximately 15 to 22.3% of patients with missed injuries had clinically significant missed injuries. Furthermore, we observed a decrease of missed pelvic and hip injuries within the last decade.</p> <p>Conclusion</p> <p>The lack of standardized studies using comparable definitions for missed injuries and clinically significant missed injuries call for further investigations, which are necessary to produce more reliable data. Furthermore, improvements in diagnostic techniques (e.g. the use of multi-slice CT) may lead to a decreased incidence of missed pelvic injuries. Finally, the standardized tertiary trauma survey is vitally important in the detection of clinically significant missed injuries and should be included in trauma care.</p

Pelvic trauma : WSES classification and guidelines

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.Peer reviewe

Prevalence of depression after TBI in a prospective cohort: The SHEFBIT study

OBJECTIVE: The objective is to measure the prevalence of depression after traumatic brain injury (TBI) and the features associated with increased risk in a cohort that reflects clinical practice. METHODS: Prospective TBI admissions to a large Teaching Hospital Emergency Department were recruited over a 2-year period. Assessments for depression and other psychosocial and global outcomes were completed at 3 months post-injury. Comparisons were made with demographic and injury features of interest to establish any associations of depression risk. RESULTS: Out of 827 individuals, 774 (94%) successfully attended follow-up. A percentage of 56.3 had depression using a HADS-D >8. Depressed individuals had higher levels of post-concussion symptoms and worse psychosocial and global outcome ratings. In multivariable analysis, features associated with depression were TBI severity, previous psychiatric history, alcohol intoxication at time of injury, female gender and nonwhite ethnicity. Those with a normal CT scan showed higher risk than those with only mild abnormality and were comparable to those with much more marked CT changes. CONCLUSION: The 3-month prevalence of depression after TBI is very high and associated with several injury and demographic features. Future long-term follow-up of this cohort aims to confirm the features that increase risk; this may allow the earlier targeting of susceptible individuals for depression interventions