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 [
[1]
]. 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 [
2
,
3
,
4
]. Evidence suggests that formal TTS reduces the rate of missed injuries by up to 38%
[
[2]
].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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Article info
Publication history
Published online: August 02, 2022
Accepted:
July 29,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
