[Tertiary survey for trauma patients : Practical recommendations of the Trauma Section of the DIVI].

The tertiary survey serves to identify injuries and their consequences in the hours and days following polytrauma. A structured process has been proven to result in a high rate of previously missed additional diagnoses, leading to subsequent changes in patient management; however, to date there are no concrete practical recommendations or widespread implementation of the tertiary survey in German trauma centers. We recommend performing the tertiary survey for the first time as early as possible in the intensive care unit, followed by repeated assessments as needed when the patient´s clinical condition changes. Furthermore, we recommend utilizing the tertiary survey as a structured re-evaluation of the patient beyond physical examination. This should include the assessment of psychological stress, a thorough review of imaging and consultative findings and the collection of additional information regarding the accident and the patient´s medical history. After compiling all information further treatment plans should be evaluated and defined. The Trauma Section of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) is developing a freely available tertiary survey form, which will undergo continuous optimization supported by scientific evaluation. In the long term, the goal is to provide a standardized tool for integration into local standard operating procedures of trauma centers, quality management systems and digital emergency care pathways.