Pervez Tamkeen, Malik Mehreen
Emergency Medicine, Combined Military Hospital, Rawalpindi, PAK.
Family Medicine, Heavy Industries Taxila (HIT) Hospital, Taxila, PAK.
Cureus. 2024 Jan 29;16(1):e53187. doi: 10.7759/cureus.53187. eCollection 2024 Jan.
In today's competitive world with a fast-paced lifestyle, trauma is on the rise and is globally recognized as the leading cause of mortality, morbidity, and disability. Despite the development of major trauma centers and the introduction of advanced trauma training courses and management guidelines, there remains a substantial risk of missed or delayed diagnosis of injuries with potentially life-changing physical, emotional, and financial implications. The proportion of such incidents is potentially higher in busy emergency departments and developing countries with fewer dedicated major trauma centers or where focused emergency and trauma training and skills development is still in its infancy. In the last decade, tertiary trauma surveys have been recognized as an important re-assessment protocol in reducing such missed injuries or delayed diagnoses in patients involved in major trauma. This naturally leads to the presumption that tertiary trauma surveys could also play an important role in observational medicine. This also brings into question whether a standardized tertiary trauma survey of major trauma patients on emergency observation units could reduce missed injuries, especially in low-income countries with fewer resources and trauma expertise. Thus, the purpose of this systematic literature review is to explore the potential role of tertiary trauma survey as a tool to reducing missed or delayed diagnosis in the emergency observation units and its applicability and feasibility in less-developed healthcare systems and in low- and middle-income countries. A broad-based systematic literature review was conducted to include electronic databases, grey literature, reference lists, and bibliographies using the keywords: tertiary trauma survey, major trauma, observational medicine, emergency observation units, clinical decision unit, adult, missed injuries, and delayed diagnosis. Over 19,000 citations were identified on initial search. Following a review of abstracts, application of inclusion and exclusion criteria, and review of the full article, 19 publications were finally selected for the purpose of this systematic literature review. Current evidence shows a general trend that tertiary trauma surveys performed 24 hours after admission play an important role in identifying injuries missed at the time of initial primary and secondary survey, and its implementation in observational medicine could prove beneficial, especially in resource-depleted healthcare systems.
在当今这个生活节奏快且竞争激烈的世界里，创伤事件不断增加，并且在全球范围内被公认为是导致死亡、发病和残疾的主要原因。尽管大型创伤中心不断发展，先进的创伤培训课程和管理指南也相继出台，但漏诊或延迟诊断损伤的风险依然很大，这可能会对患者的身体、情感和经济状况产生改变人生的影响。在繁忙的急诊科以及专门的大型创伤中心较少、急诊和创伤专项培训及技能发展仍处于起步阶段的发展中国家，此类事件的比例可能更高。在过去十年中，三级创伤检查已被视为一项重要的重新评估方案，可减少重大创伤患者的漏诊损伤或延迟诊断情况。这自然而然地让人推测，三级创伤检查在观察医学中也可能发挥重要作用。这也引发了一个问题，即在急诊观察病房对重大创伤患者进行标准化的三级创伤检查，是否能够减少漏诊损伤，尤其是在资源和创伤专业知识较少的低收入国家。因此，本系统文献综述的目的是探讨三级创伤检查作为一种工具在减少急诊观察病房漏诊或延迟诊断方面的潜在作用，以及其在欠发达医疗系统和低收入及中等收入国家的适用性和可行性。我们进行了一项广泛的系统文献综述，通过使用关键词“三级创伤检查”“重大创伤”“观察医学”“急诊观察病房”“临床决策单元”“成人”“漏诊损伤”和“延迟诊断”，纳入了电子数据库、灰色文献、参考文献列表和书目。初步搜索共识别出19000多条引用。在对摘要进行审查、应用纳入和排除标准以及阅读全文后，最终选择了19篇出版物用于本系统文献综述。目前的证据显示出一种总体趋势，即入院24小时后进行的三级创伤检查在识别初次初级和次级检查时漏诊的损伤方面发挥着重要作用，并且其在观察医学中的实施可能会被证明是有益的，尤其是在资源匮乏的医疗系统中。
