Missed injuries in the multiply traumatized.

The delayed diagnosis of injuries in traumatized patients is a recognized problem. A retrospective review of trauma patients admitted to a major teaching hospital has been performed. The records of all patients admitted to the intensive care unit (ICU) have been checked to determine the incidence of late diagnosed injuries. The notes written by the staff of the emergency department and the ICU, and the attending surgical registrars have been used as the criteria of initial diagnosis. Comparing them to the injuries listed in the progress notes, investigation reports, discharge summary and follow-up outpatient notes led to the discovery of a number of missed injures (19 of 50 patients had one or more). In 4 cases the management involved further surgery due to new diagnoses. This is consistent with overseas literature. A review of the literature is presented and methods to improve the missed diagnosis rate are discussed.