Use of the Injury Severity Score to monitor diagnostic accuracy in the early assessment of road trauma.

A retrospective review of 279 hospital admissions at two Melbourne hospitals was conducted to develop a method for identifying diagnostic error using the Injury Severity Score (ISS) as a model for clinical audit. Two scores were calculated for each patient, the first according to injuries diagnosed on initial assessment in the Emergency Department and the second according to final, confirmed diagnoses upon discharge from hospital. Diagnostic errors were identified as discrepancies between the initial and final scores. ISS discrepancies were found in 48 cases (17.2%). Some were clinically significant errors of diagnosis while others reflected inaccurate injury description or record keeping. Abdominal injuries were the most frequently missed, followed in decreasing order by spinal, thoracic, extremities (limbs), head/face and external injuries (skin and subcutaneous tissues). The frequency and pattern of injury misdiagnosis concurs with the findings of other studies. The diagnostic error rate was found to increase with injury severity and with the number of anatomic body regions involved. The authors suggest that comparing initial and final ISS provides a convenient mechanism for the audit of early diagnosis in trauma cases.