Reducing missed injuries at a level II trauma center

J Trauma Nurs. Jul-Sep 2006;13(3):89-95. doi: 10.1097/00043860-200607000-00003.


The phenomenon of missed injury in trauma patients has been recognized for some time. Tertiary examination has been proposed as one strategy to decrease the incidence of missed injuries. The tertiary examination is a comprehensive reevaluation that includes a repeated head-to-toe examination and review of all laboratory and radiologic studies, completed within 24 hours of admission. The purpose of this study was to assess the statistical significance of missed injuries discovered through tertiary examinations at a level II trauma center. Over a period of 6 months, a tertiary examination was completed before discharge of admitted patients who met activation criteria. Of the 90 patients, 13 had a missed injury (incidence of 14%), which was significant. The 16 missed injuries represented only 2.7% of the total 589 injuries, which was not significant. The most commonly missed injuries were fractures of the extremities. We propose that tertiary examinations be adopted as a standard of care for patients admitted to level II trauma centers.

MeSH terms

  • Diagnostic Errors / methods
  • Diagnostic Errors / nursing
  • Diagnostic Errors / prevention & control*
  • Documentation
  • Emergency Service, Hospital
  • Female
  • Forms and Records Control
  • Humans
  • Incidence
  • Male
  • Medical Records
  • Midwestern United States / epidemiology
  • Multiple Trauma / diagnosis*
  • Multiple Trauma / epidemiology
  • Nurse Clinicians / organization & administration
  • Nurse's Role
  • Nursing Assessment
  • Nursing Evaluation Research
  • Patient Admission
  • Patient Care Team / organization & administration
  • Patient Discharge
  • Physical Examination / methods*
  • Physical Examination / nursing
  • Physical Examination / standards
  • Practice Guidelines as Topic
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Trauma Centers
  • Traumatology / methods*