Robertson R, Mattox R, Collins T, Parks-Miller C, Eidt J, Cone J
Department of Surgery, University of Arkansas for Medical Sciences, University Hospital of Arkansas, Little Rock 72205, USA.
Am J Surg. 1996 Nov;172(5):564-7; discussion 567-8. doi: 10.1016/S0002-9610(96)00247-4.
Missed injuries can lead to delays. In the rural environment, where patients are frequently seen in multiple hospitals prior to reaching the trauma center, different problems arise.
Level-1 trauma center admissions from January 1993 through June 1995 were reviewed. Missed injuries were those not identified within 24 hours of injury. Data extracted included demographics, mechanism, severity and outcome. Comparisons were made between missed injury patients and typical trauma patients.
Of 3,996 patients, 70 missed injuries were identified in 56 patients. Compared with typical trauma patients, missed injury patients suffered more blunt trauma, were more severely injured, had longer intensive care unit and hospital stays, and a lower mortality rate. Transferred patients accounted for 60% of missed injuries.
Transferred patients with blunt injury have the highest risk for missed injury. Delayed transports and prior examination may contribute to complacency. All trauma patients must be repeatedly evaluated thoroughly, and all diagnostic studies reviewed for adequacy.
漏诊的损伤可能导致治疗延误。在农村地区，患者在到达创伤中心之前经常在多家医院就诊，这就出现了不同的问题。
回顾了1993年1月至1995年6月期间一级创伤中心的入院病例。漏诊的损伤是指在受伤后24小时内未被发现的损伤。提取的数据包括人口统计学资料、受伤机制、严重程度和治疗结果。对漏诊损伤患者和典型创伤患者进行了比较。
在3996例患者中，56例患者存在70处漏诊损伤。与典型创伤患者相比，漏诊损伤患者遭受的钝性创伤更多，损伤更严重，重症监护病房和住院时间更长，死亡率更低。转诊患者占漏诊损伤的60%。
钝性损伤的转诊患者漏诊风险最高。转运延迟和之前的检查可能导致麻痹大意。所有创伤患者都必须反复进行全面评估，并且要对所有诊断检查的充分性进行复查。
