BACKGROUND: The occurrence of delayed diagnosis of injury (DDI) among pediatric trauma patients represents a breakdown in trauma care. Although some DDI may be unavoidable, the rate of DDI may be used as a measure of quality improvement. OBJECTIVE: We sought to investigate DDI in admitted pediatric trauma patients while a designated pediatric trauma response team was used and compare this with the prior incidence of DDI (4.3%) before initiation of the response team. METHODS: Primary Children's Medical Center (PCMC) is a regional tertiary pediatric trauma center. This analysis used the prospectively gathered PCMC Trauma Database, and included all hospitalized pediatric trauma patients from 1997 through 2000. RESULTS: A total of 3265 patients were included; no patients were excluded. A DDI occurred in 15 (0.46%; 95% CI: 0.31, 0.79) trauma patients. The DDI patients were more severely injured with significantly higher Injury Severity Scores, lower TRISS Probability of Survival values, longer hospitalizations (P < or = 0.05, Mann-Whitney U), and were more frequently admitted to the PICU (P < or = 0.05, chi2) than the non-DDI patient population. In a previous study, our incidence of missed injury was 4.3% (50/1175; 95% CI: 3.3, 5.6); with implementation of a designated trauma response team and trauma service, the incidence of DDI was reduced nearly 10-fold to 0.46% (15/3265; 95% CI: 0.31, 0.79). CONCLUSIONS: Implementation of an effective trauma team and trauma service was associated with a significant reduction in DDI.
BACKGROUND: The occurrence of delayed diagnosis of injury (DDI) among pediatric traumapatients represents a breakdown in trauma care. Although some DDI may be unavoidable, the rate of DDI may be used as a measure of quality improvement. OBJECTIVE: We sought to investigate DDI in admitted pediatric traumapatients while a designated pediatric trauma response team was used and compare this with the prior incidence of DDI (4.3%) before initiation of the response team. METHODS: Primary Children's Medical Center (PCMC) is a regional tertiary pediatric trauma center. This analysis used the prospectively gathered PCMC Trauma Database, and included all hospitalized pediatric traumapatients from 1997 through 2000. RESULTS: A total of 3265 patients were included; no patients were excluded. A DDI occurred in 15 (0.46%; 95% CI: 0.31, 0.79) traumapatients. The DDIpatients were more severely injured with significantly higher Injury Severity Scores, lower TRISS Probability of Survival values, longer hospitalizations (P < or = 0.05, Mann-Whitney U), and were more frequently admitted to the PICU (P < or = 0.05, chi2) than the non-DDIpatient population. In a previous study, our incidence of missed injury was 4.3% (50/1175; 95% CI: 3.3, 5.6); with implementation of a designated trauma response team and trauma service, the incidence of DDI was reduced nearly 10-fold to 0.46% (15/3265; 95% CI: 0.31, 0.79). CONCLUSIONS: Implementation of an effective trauma team and trauma service was associated with a significant reduction in DDI.
Authors: Dowin H Boatright; Richard L Byyny; Emily Hopkins; Katherine Bakes; Jennifer Hissett; Java Tunson; Joshua S Easter; Comilla Sasson; Jody A Vogel; Denis Bensard; Jason S Haukoos Journal: J Am Coll Surg Date: 2013-04-23 Impact factor: 6.113
Authors: Hardeep Singh; Mark L Graber; Stephanie M Kissam; Asta V Sorensen; Nancy F Lenfestey; Elizabeth M Tant; Kerm Henriksen; Kenneth A LaBresh Journal: BMJ Qual Saf Date: 2011-11-30 Impact factor: 7.035
Authors: Adil H Haider; Jean-Stephane David; Syed Nabeel Zafar; Pierre-Yves Gueugniaud; David T Efron; Bernard Floccard; Ellen J MacKenzie; Eric Voiglio Journal: Ann Surg Date: 2013-07 Impact factor: 12.969
Authors: Ashimiyu B Durojaiye; Scott Levin; Matthew Toerper; Hadi Kharrazi; Harold P Lehmann; Ayse P Gurses Journal: J Am Med Inform Assoc Date: 2019-06-01 Impact factor: 4.497