Janjua K J, Sugrue M, Deane S A
Liverpool Hospital, New South Wales, Australia.
J Trauma. 1998 Jun;44(6):1000-6; discussion 1006-7. doi: 10.1097/00005373-199806000-00012.
This study prospectively evaluated the prevalence, clinical significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant missed injury, tertiary survey, and contributing factors were defined. Tertiary survey was conducted within 24 hours.
Of 206 patients, 134 patients (65%) had 309 missed injuries composing 39% of all 798 injuries seen. Tertiary trauma survey detected 56% of early missed injuries and 90% of clinically significant missed injuries within 24 hours. Clinically significant missed injuries occurred in 30 patients with complications in 11 patients and death in two patients. Of 224 contributing errors, 123 errors were in clinical assessment, 83 errors were in radiology, 14 errors were patient related, and four errors were technical. The missed injury rate was significantly higher in patients with multiple injuries and in those involved in road crashes.
Secondary trauma survey is not a definitive assessment and should be supplemented by tertiary trauma survey.
本研究前瞻性评估了早期漏诊损伤的发生率、临床意义、相关因素以及三级检查在降低创伤住院患者漏诊损伤发生率方面的作用。定义了漏诊损伤、具有临床意义的漏诊损伤、三级检查及相关因素。三级检查在24小时内进行。
206例患者中，134例（65%）存在309处漏诊损伤，占所见全部798处损伤的39%。三级创伤检查在24小时内发现了56%的早期漏诊损伤和90%的具有临床意义的漏诊损伤。30例患者出现具有临床意义的漏诊损伤，其中11例出现并发症，2例死亡。在224个导致漏诊的错误中，123个错误发生在临床评估中，83个错误发生在放射检查中，14个错误与患者相关，4个错误是技术方面的。多发伤患者和道路交通事故患者的漏诊损伤率显著更高。
二次创伤检查并非确定性评估，应由三级创伤检查加以补充。
