Delayed injuries in the emergency department in hospitalised trauma patients

• Published in: Trauma (London, England) Vol. 22; no. 1; pp. 64 - 69
• Main Authors: Orun, Serhat, Akoz, Ayhan, Duman, Ali, Ahmet Turkdogan, Kenan, Türe, Mevlüt, Unlu, Derya
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2020; Sage Publications Ltd
• Subjects: Emergency medical services; Evaluation; Injuries; Injury prevention; Musculoskeletal system; Patients; Radiology; Supervisors; Trauma; Trauma centers; trauma; Delayed injuries; emergency services
• ISSN: 1460-4086; 1477-0350
• DOI: 10.1177/1460408619837845

Introduction
Busy emergency departments are associated with medical errors in care and evaluation for unstable trauma patients. Our study aimed to determine the extent, causes and adverse clinical consequences of missed injuries and delayed diagnoses in patients hospitalised with trauma in a Turkish Level 3 emergency department, and provide recommendations for emergency service workers and supervisors to help them reduce the number of injury diagnoses that are delayed.
Methods
In our prospective study, a total of 515 emergency department patients presenting with trauma between 1 July 2014 and 1 July 2015 were examined by an emergency physician and by a consultant, if necessary. Identified injuries were recorded using case forms, and hospitalised patients were discharged when their treatment was completed. After the patients were discharged their files were reviewed again and new injuries, different from those recorded in the case forms, were investigated.
Results
Of the 515 patients included, it was shown that an injury diagnosis had been delayed in 21 (3.9%). Of these injuries, 65% were related to the musculoskeletal system. Insufficient clinical evaluation of 95% of the patients who had a missed injury was identified, and, in 70% of missed injuries, the radiology reports had been delayed or incorrectly completed.
Conclusion
We believe that the delayed injury rate can be reduced in trauma patients with the use of fast and reliable radiological support and the intervention of a multidisciplinary trauma team.