Missed injuries is defined as an injury found after the initial complete patient assessment and diagnostic studies that was directly related to the traumatic event and was identified after first 24 hours following admission. Missed injuries increase the risk of death, result in significant long-term disability, are a common reason for litigation and embarrassment to the surgeon and institution.
Materials and Methods: This is a prospective study of 671 admissions in Orthopaedics indoor patients of Adichunchanagiri Institute of Medical Sciences for the period of 10 months from 1st January 2016 to 31st October 2016. The patient notes and radiology reports was reviewed daily while each patient was an inpatient up to the end-point of discharge from hospital.
Results: 18 patients out of 671 patients were identified with delayed diagnoses of the injury. Incidence rate of missed injury was 2.68%. The different parameters that were considered for this study are sex of patient, age, mechanism of injury, whether patient was under the influence of alcohol, GCS <8, whether patient was under shock and anatomical distribution of the missed injuries. 5 patients were under the influence of alcohol; 5 patients had GCS<8; 4 patients had shock. 3 patients had missed neurological injury. 5 patients had missed axial skeleton injury; 4 patients had missed upper extremity injuries whereas 6 patients had missed lower extremity injuries.
Conclusions: All body regions are at risk, such as the spine, ribs, and extremities. Factors to be considered in examining missed injuries are altered level of consciousness; hemodynamic instability; presentation with multi-trauma; low index of suspicion; technically inadequate radiology exams; inadequate clinical assessment, misinterpretation of studies and late presentation of observable findings. Tertiary survey with repeated assessments, both clinical and radiological, are mandatory to diminish this problem.