Missed injuries in pre-hospital trauma patients.

Background: During primary survey of trauma patients, missed injuries and delayed diagnosis can be a potential source of morbidity and mortality.

Objective: To assess type and frequency of missed injuries in prehospital care in trauma patients and to analyze their contributing factors and implications.

Methods:   It is a descriptive and analytic prospective study. It was performed over six months which had included 200 trauma patients. The initial assessment made by the out-of hospital team of Sousse was compared to the second survey made in the emergency room and intensive care unit after the radiological assessment.

Results: Sixty seven (67) missed injuries were discovered in 51 patients, so 25.5% missed injuries incidence. These injuries were avoidable in 35.82% of cases. Twenty (20) injuries (29.85%) had clinically significant outcomes. Injuries are missed in the abdomen in 62.5% of cases, in the pelvis in 61.11% of cases, in the chest in 41.66% of cases, in the spine in 38.06 % of cases and in 20% of cases in the limbs. Multiple contributing factors were assigned, the most important were: the hemodynamic instability (Systolic blood pressure less than 90 mmHg), the tachycardia and the low RTS. Altered level of consciousness (GCS of twelve or lower), multiple and violence of the trauma were observed but not retained as predictive factors of missing injuries.

Conclusion:   Our study showed higher rates of severe missed injuries mainly in abdomen and pelvis. Circulatory instability and low RTS were assigned as significant factors predicting of this obviousness. Various solutions are proposed to prevent missed during the first assessment in prehospital care.