Management of missed injuries in polytrauma patient

Abstract

According CRICO Strategies, among the most common and costly medical errors committed in emergency departments are establishing a delay in diagnosis or misdiagnosis, which can have a tragic end for the patient. The management of multiple trauma patients presents a worldwide diagnostic and therapeutic challenge to trauma, orthopedic and general surgeons. Significant injuries can be missed during primary and secondary surveys in multiply injured patients, for whom resuscitation, diagnosis and therapy have to proceed simultaneously. Many factors involved in the initial resuscitation of the multiple trauma patients, such as altered level of consciousness, hemodynamic instability, or inexperience and inadequate diagnostic evaluation, may lead to missed injuries or a „medical errors”. The injuries can be missed at any stage of the management of the trauma patient, including intraoperatively, and may involve all regions of the body. Management of polytraumatised patient need application of primary and secondary survey protocols, as is the ATLS (Advanced Trauma Life Support) protocol, will minimize the chance of life-threatening critical medical errors. Also, intraoperative careful approach is needed for all patients, but especially for hemodynamically unstable patients, giving priority to other regions of the human body than appreciated as trauma, for the presence of vascular lesions. Examination of polytraumatised patient with special vigilance in a tertiary look, after patient returns to consciousness, will help detect missed lesions during the initial assessment. In most cases we detect missed lesions. This approach will lead to early detection of missed injuries and reduce lost their consequences.