Missed Injuries in Multiple Trauma Patients: a Tertiary Care Experience in Tanzania

Abstract

Background: Missed injuries remain a worldwide problem in all trauma centers and contribute significantly to high morbidity and mortality among trauma patients. There is paucity of information regarding missed injuries in Tanzania. The aim of this study was to establish the incidence, contributing factors, and short-term outcome of missed injuries among polytraumatized patients in our setting.

Methods: This was a one-year duration (from January to December 2009) prospective cohort study involving all multiple trauma patients (ISS > 16) admitted to Bugando Medical Centre. After informed consent to participate in the study, all patients were consecutively enrolled in the study. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer software version 11.5.

Results: Ninety six of 462 patients (incidence, 20.1%) had 112 missed injuries. Head and the neck (46.4%) was the most common body region affected. Clinical error (57.1%) was the most common factor contributed to the occurrence of missed injuries. Of the factors contributing to missed injuries, 57.4% were potentially avoidable and 42.6% were unavoidable. There was statistically significant difference in the mean ISS, mean GCS, orotracheal intubation, patient’s arrival time and seniority of the attending doctor between patients with missed injuries and those without missed injuries (p-value <0.001). Mortality in patients with missed injuries was 19.8% compared with 8.7% in patients without missed injuries (p-value <0.001). Among the deaths in patients with missed injuries, 57.9% were directly attributable to missed injuries (O.R. = 14.8, p-value =0.001, 95% CI = 6.1- 32.46). Patients with missed injuries had longer stays in the hospital compared with patients without missed injuries (p-value <0.001).

Conclusion: The incidence of missed injuries at BMC is high in patients with high ISS, low GCS, orotracheal intubation and those who reported during night hours. A high index of suspicious is needed when dealing with such a group of patients. The majority of missed injuries are potentially avoidable by repeated assessments both clinically and radiologically and by staff redistribution to address the increase of missed injuries during night hours. Implementation of a tertiary trauma survey should be routine in the Accident & Emergency department to minimize the occurrence of missed injuries.