Tertiary survey in the management of patients with multiple injuries

Background: Implementing tertiary trauma surveys can reduce the incidence of clinically

significant missed injury, thereby reducing morbidity and mortality in patients with

multiple injuries.

Methods: Prospective study of patients admitted to the critical care unit with multiple

injuries. The patients were over the age of 16 years and survived at least 24 hours.

Patients undergoing tertiary examination were compared to a historical control group

that did not undergo additional assessment. We recorded missed injuries and clinically

significant missed injuries in both groups. Also analyzed were the main errors associated

with the appearance of missed injuries, avoidable risk factors, mortality, and

complications in both groups.

Results: A total of 119 patients underwent tertiary examination and their data were

compared to those of 117 in the historical control group. The incidence of missed injuries

was lower in the test period (15.13%) than the control period (40.17%). The incidence of

clinically significant missed injuries was also lower in the test period (3.36% vs 17.09 in

the control period). Mortality fell to 4.25% with tertiary examination (vs 10.25% in the

control period), and mortality due to multiorgan failure was 0% in the test period.

Radiologic errors were fewer with implementation of tertiary trauma surveys and

communication and surgical errors disappeared. The main risk factors for detecting

clinically significant missed injuries were to blood pressure, the number of injuries and,

particularly, the inclusion of a tertiary examination or not.

Conclusion: Tertiary trauma surveys should be considered an obligatory component of

the initial management of patients with multiple injuries.