Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Injury. 2012 Dec;43(12):2012-7. doi: 10.1016/j.injury.2011.09.006. Epub 2011 Oct 18.
On 25th February 2009, a Boeing 737 crashed nearby Amsterdam, leaving 126 victims. In trauma patients, some injuries initially escape detection. The aim of this study was to evaluate the incidence of Delayed Diagnosis of Injury (DDI) and the tertiary survey on the victims of a plane crash, and the effect of ATLS(®) implementation on DDI incidence.
Data from all victims were analysed with respect to hospitalisation, DDI, tertiary survey, ISS, Glasgow Coma Score (GCS), injuries (number and type) and emergency intervention. Clinically significant injuries were separated from non-clinically significant injuries. The data were compared to a plane crash in the UK (1989), which occurred before ATLS(®) became widely practiced.
All 126 victims of the Dutch crash were evaluated in a hospital; 66 were hospitalised with a total of 171 clinically significant injuries. Twelve (7%) clinically significant DDIs were found in 8 patients (12%). In 65% of all patients, a tertiary survey was documented. The incidence of DDI in patients with an ISS ≥ 16 (n=13) was 23%, vs. 9% in patients with ISS <16. Patients with >5 injuries had a DDI incidence of 25%, vs. 12% in patients with ≤ 5 injuries. Head injury patients had a DDI incidence of 19%, patients without head injury 10%. Fifty percent of patients who needed an emergency intervention (n=4) had a DDI; 3% of patients who did not need emergency intervention. Eighty-one survivors of the UK crash had a total of 332 injuries. DDIs were found in 30.9% of the patients. Of all injuries 9.6% was a DDI. The incidence of DDI in patients with >5 injuries was 5%, vs. 8% in those with ≤ 5 injuries.
DDI in trauma still happen. In this study the incidence was 7% of the injuries in 12% of the population. In one third of the patients no tertiary survey was documented. A high ISS, head injury, more than 5 injuries and an emergency intervention were associated with DDI. The DDI incidence in our study was lower than in victims of a previous plane crash prior to ATLS implementation.
2009 年 2 月 25 日，一架波音 737 在阿姆斯特丹附近坠毁，造成 126 名遇难者。在创伤患者中，有些损伤最初会漏诊。本研究旨在评估损伤延迟诊断（DDI）的发生率，并对飞机失事受害者进行三级检查，以及评估 ATLS（®）实施对 DDI 发生率的影响。
对所有受害者的住院、DDI、三级检查、ISS、格拉斯哥昏迷评分（GCS）、损伤（数量和类型）和紧急干预情况进行分析。将有临床意义的损伤与无临床意义的损伤分开。将这些数据与英国（1989 年）的一次飞机失事进行比较，该飞机失事发生在 ATLS（®）广泛应用之前。
荷兰坠机的 126 名遇难者均在医院接受评估；66 人住院，共 171 处有临床意义的损伤。8 名患者（12%）有 12 处（7%）有临床意义的 DDI。在 65%的患者中，有记录的三级检查。ISS≥16 的患者（n=13）的 DDI 发生率为 23%，ISS<16 的患者为 9%。有>5 处损伤的患者的 DDI 发生率为 25%，而有≤5 处损伤的患者为 12%。头部损伤患者的 DDI 发生率为 19%，无头部损伤的患者为 10%。50%需要紧急干预的患者（n=4）有 DDI；3%不需要紧急干预的患者有 DDI。英国坠机事件中的 81 名幸存者共有 332 处损伤。在 30.9%的患者中发现 DDI。所有损伤中，9.6%为 DDI。有>5 处损伤的患者的 DDI 发生率为 5%，有≤5 处损伤的患者为 8%。
创伤后仍会发生 DDI。在这项研究中，发病率为 12%的人群中有 7%的损伤。三分之一的患者未记录三级检查。ISS 较高、头部损伤、>5 处损伤和紧急干预与 DDI 相关。本研究中的 DDI 发生率低于 ATLS 实施前的一次飞机失事的受害者。
