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Accurate completion of tertiary trauma survey for inpatients at a non-trauma centre following significant trauma

      Highlights

      • We showed a poor completion rate of only 30%. There was a high percentage of previously undetected injuries within the study population who received a TTS. This may suggest the possibility that many injuries are missed within the remaining 70% population that did not receive a TTS.”
      • “The inclusion criteria of this audit are wider than the comparative studies. Rather than limiting it to patients who had triggered a trauma call, we chose to expand the inclusion criteria to be more representative of patients who we thought could benefit from a TTS.”
      • “Arguably, the inclusion criteria of this audit are more representative of patients who need tertiary surveys.”

      Abstract

      Introduction

      A tertiary trauma survey (TTS) is a structured, comprehensive top-to-toe examination following major trauma [
      • Ferree S.
      • Houwert R.M.
      • van Laarhoven J.J.
      • Smeeing D.P.
      • Leenen L.P.
      • Hietbrink F.
      Tertiary survey in polytrauma patients should be an ongoing process.
      ]. Literature suggests that the ideal time frame for the initial TTS should be completed within 24-hours of a patient's admission and repeated at important moments [
      • Thomson C.B.
      • Greaves I.
      Missed injury and the tertiary trauma survey.
      ,
      • Biffl Walter L.MD
      • Harrington David T.MD
      • Cioffi William G
      MD implementation of a tertiary trauma survey decreases missed injuries.
      ,
      • Brooks A.
      • Holroyd B.
      • Riley B.
      Missed injury in major trauma patients.
      ]. Evidence suggests that formal TTS reduces the rate of missed injuries by up to 38% [
      • Thomson C.B.
      • Greaves I.
      Missed injury and the tertiary trauma survey.
      ].

      Aims

      To determine the rate of TTS being conducted in trauma patients in a tertiary hospital without an admitting trauma service.

      Methods

      We performed a retrospective analysis of adult trauma patients admitted to Middlemore Hospital (MMH) over six months. To be included, patients were either deemed to have a significant mechanism of injury or triggered a trauma call when arriving in the Emergency Department.

      Results

      We identified 246 patients who met our criteria for requiring a TTS. 74 (30%) had a TTS completed. Of those completed, 22 (30%) were documented using a standardised form. 35 (47%) were done within the ideal timeframe (24 h); a further 21 (28%) were done within 48 h. House Officers (Junior Medical Officers) conducted the majority (80%), with the remainder being done by final-year medical students (12%), Registrars (Residents) (4%) and Consultants (Attendings) (4%). Of the 74 TTS that were completed, 21 (28%) detected a possible new injury, with 22% leading to further investigations being ordered. 14 (19%) were found to have a previously undetected, clinically significant injury on TTS (defined as ‘injuries requiring further clinical intervention’). Most patients (90%) were admitted to either General Surgery or Orthopaedics. Sixty-two (54%) of patients admitted to General Surgery received a TTS; compared to just 11 (10%) admitted under Orthopaedics and 1 of 24 (4%) admitted to other specialities (including Hands, Plastics, Maxillo-Facial, Gynaecology and Medicine).

      Conclusion

      30% of patients requiring a TTS received one. 19% of TTS conducted detected clinically significant injuries.

      Keywords

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