The yield of tertiary survey in patients admitted for observation after trauma
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ORIGINAL ARTICLE
The yield of tertiary survey in patients admitted for observation after trauma Gijs Jacob Jan van Aert1 · Jelle Corneel van Dongen2 · Niels Cornelis Adrianus Sebastianus Berende1 · Hendrikus Gerardus Wilhelmus de Groot1 · Pieter Boele van Hensbroek1 · Philip Marcel Jozef Schormans1 · Dagmar Isabella Vos1 Received: 6 May 2020 / Accepted: 21 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Existing literature on trauma tertiary survey (TTS) focusses on multitrauma patients. This study examines the yield of the TTS in trauma patients with minor (AIS 1) or moderate (AIS 2) injury for which immediate hospitalization is not strictly indicated. Method A single center retrospective cohort study was performed in a level II trauma center. All hospitalized trauma patients with an abbreviate injury score (AIS) of one or two at the primary and secondary survey were included. The primary outcome was defined as any missed injury found during TTS (Type 1). Secondary outcomes were defined as any missed injury found after TTS but during admission (Type 2); overall missed injury rate; mortality and hospital length of stay. Results Out of 388 included patients, 12 patients (3.1%) had a type 1 missed injury. ISS and alcohol consumption were associated with an increased risk for type 1 missed injuries (resp. OR = 1.4, OR = 5.49). A type 2 missed injury was only found in one patient. This concerned the only case of trauma related mortality. Approximately one out of five patients were admitted for more than 2 days. These patients were significantly older (66 vs. 41 years, p 30 km/h, Moderate speed: 30 km/h
Table 4 Characteristics of type 1 missed injuries
Age mean (range) Gender = female (%) BMI [median (IQR)] AIS 2 (%) ISS [median (IQR)] Mortality ASA 3 and 4 Alcohol = yes (%) Hospital length of stay*** [median (IQR)]
Negative TTS N = 376
Positive TTS N = 12
p
Odds ratio [CI]
47.00 [26.00, 63.00] 147 (39.1%) 25.00 [22.00, 28.00] 130 (34.6%) 3.00 [1.00, 4.00] 0 66 (17.6%) 23 (6.1%) 1.00 [1.00, 2.00]
50 [21.75, 71.25] 4 (30.8%) 24.00 [21.00, 27.00] 6 (50.0%) 5.00 [1.25, 7.50] 0 3 (23.1%) 3 (23.1%) 1.50 [1.00, 6.75]
0.883* 0.772** 0.383* 0.357** 0.038*
1.001 [0.977–1.026] 0.779 [0.230–2.633] 0.924 [0.805–1.061] 1.892 [0.598–5.984] 1.389 [1.079–1.788]
0.454** 0.039** 0.370*
1.566 [0.413–5.940] 5.116 [1.296–20.194] 1.153 [1.054–1.262]
TTS trauma tertiary survey, MVA motor vehicle accident, High speed: > 30 km/h, moderate speed: 2 days) Out of the 388 patients, 20 underwent surgery (Table 5) during the primary admission and were therefore excluded for the hospital length of stay analysis. Of the remaining 366 patients, 73 patients (19.9%) were hospitalized for more than 2 days (Table 6). These patients were significantly older compared to patients who were admitted for 1 or 2 days (66 vs. 41 years old, p > 0.001), had a higher AIS (AIS = 2: 49.3% vs. 29.4%, p = 0.002) and ISS (4.00 vs. 3.00, p = 0.007) and also the ASA-score was significantly higher (ASA 3
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