Advertisement

Errors in Polytrauma

  • Franco Guida
  • Giorgio Bocchini
  • Giacomo Sica
  • Anna Frezza
  • Mariano Scaglione

Abstract

In the managing of traumatized patients, and even more so in dealing with normal dynamic diagnostics, an error can increase the rate of mortality and morbidity. While procedural or clinical-diagnostic errors are more frequent in medical facilities that are not dedicated to trauma, they can involve patients in highly specialized trauma centers as well. The occurrence of these errors, in a wider sense, can be explained by the different dynamics in relation to the seriousness of the trauma (dyminor or major). Most diagnostic errors (dydowngrading of an injury) in radiology occur using traditional imaging studies, i.e., plain films and ultrasound, because of their intrinsic low resolution and/or limited field of view. On the other hand, the use of MDCT in trauma patients requires the adoption of tailored protocols and skill to highlight subtle or even minimal signs of injuries, especially in the subclinical status [1].

Keywords

Appendicular Skeleton Parenchymal Hematoma Scaphoid Bone Traditional Radiology Specialize Trauma Center 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Ptak T, Rhea T J, Novelline A R (2001) Experience of a continuous, single pass whole body multidetector CT protocol for trauma. Emergency Radiology 8:250–256CrossRefGoogle Scholar
  2. 2.
    Potenza B, Hoyt D, Coimbra R et al (2004) Trauma research and education foundation. The epidemiology of serious and fatal injury in San Diego County over an 11-year period. J Trauma 56:68–75PubMedCrossRefGoogle Scholar
  3. 3.
    Brooks A, Holroyd B, Riley B (2004) Missed injury in major trauma patients. Injury 35:407–410PubMedCrossRefGoogle Scholar
  4. 4.
    Farahmand N, Sirlin CB, Brown MA et al (2005) Hypotensive patients with blunt abdominal trauma: performance of screening US. Radiology 235:436–443PubMedCrossRefGoogle Scholar
  5. 5.
    Samilson RL, Prieto V (1983) Posterior dislocation of the shoulder in athletes. Clin Sports Med 2:369–378PubMedGoogle Scholar
  6. 6.
    Hawkins RJ, Neer CS, Pianta RM et al (1987) Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 69:9–18PubMedGoogle Scholar
  7. 7.
    Neviaser TJ (1980) Old unreduced dislocations of the shoulder. Orthop Clin North Am 11:287–294PubMedGoogle Scholar
  8. 8.
    Schultz TJ, Jacobs B, Patterson RL (1969) Unrecognized dislocations of the shoulder. J Trauma 9:1009–1023CrossRefGoogle Scholar
  9. 9.
    Herzberg G, Comtet JJ, Linscheid RL et al (1993) Perilunate dislocations and fracture dislocations: a multicenter study. J Hand Surg Am 18:768–779PubMedCrossRefGoogle Scholar
  10. 10.
    Perron AD, Brady WJ, Keats TE et al (2001) Orthopedic pitfalls in the ED: lunate and perilunate injuries. Am J Emerg Med 19:157–162PubMedCrossRefGoogle Scholar
  11. 11.
    Ring D, Jupiter JB, Herndon JH (2000) Acute fractures of the scaphoid. J Am Acad Orthop Surg 8:225–231PubMedGoogle Scholar
  12. 12.
    Ritchie JV, Munter DW (1999) Emergency department evaluation and treatment of wrist injuries. Emerg Med Clin North Am 17:823–842PubMedCrossRefGoogle Scholar
  13. 13.
    Berger RA (1997) The ligaments of the wrist: a current overview of anatomy with consideration of their potential functions. Hand Clin 13:63–82PubMedGoogle Scholar
  14. 14.
    Nguyen DT, McCue FC, Urch SE (1998) Evaluation of the injured wrist on the field and in the office. Clin Sports Med 17:421–432PubMedCrossRefGoogle Scholar
  15. 15.
    Zemel MP, Stark HH (1986) Fractures and dislocations of the carpal bones. Clin Sports Med 5:709–723PubMedGoogle Scholar
  16. 16.
    Wackerle JF (1987) A prospective study identifying the sensitivity of radiographic findings and the efficacy of clinical findings in carpal navicular fractures. Ann Emerg Med 16:733–737CrossRefGoogle Scholar
  17. 17.
    Mower WR, Oh JY, Zucker MI et al (2001) Occult and secondary injuries missed by plain radiography of the cervical spine in blunt trauma patients. Emerg Radiol 8:200–206CrossRefGoogle Scholar
  18. 18.
    Woodring JH, Lee C (1993) The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. J Trauma 34:32–39PubMedCrossRefGoogle Scholar
  19. 19.
    Davis JW, Phreaner DL, Hoyt DB et al (1993) The etiology of missed cervical spine injuries. J Trauma 34:342–346PubMedCrossRefGoogle Scholar
  20. 20.
    Daffner RH, Wippold FJ II, Bennett DL et al (2009) ACR appropriateness criteria suspected spine trauma. http://www.guideline.gov/content.aspxGoogle Scholar
  21. 21.
    Como JJ, Diaz JJ Jr, Dunham CM et al (2009) Practice management guidelines for identification of cervical spine injuries following trauma-update from the Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee. http://www.east.org/tpg/Google Scholar
  22. 22.
    Diaz JJ Jr, Cullinane DC, Altman DT et al (2006) Practice management guidelines for the screening of thoracolumbar spine fracture. http://www.east.org/tpg/tlspineGoogle Scholar
  23. 23.
    Cain G, Shepherdson J, Elliott V et al (2010) Imaging suspected cervical spine injury: plain radiography or computed tomography? Systematic review. Radiography 16:68–77CrossRefGoogle Scholar
  24. 24.
    Roos JE, Hilfiker P, Platz A et al (2004) MDCT in emergency radiology: is a standardized chest or abdominal protocol sufficient for evaluation of thoracic and lumbar spine trauma? Am J Roentgenol 183:959–968Google Scholar
  25. 25.
    Wintermark M, Mouhsine E, Theumann N et al (2003) Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology 227:681–689PubMedCrossRefGoogle Scholar
  26. 26.
    Beaunoyer M, St-Vil D, Lallier M et al (2001) Abdominal injuries associated with thoracolumbar fractures after motor vehicle collision. J Pediatr Surg 36:760–762PubMedCrossRefGoogle Scholar
  27. 27.
    Krueger MA, Green DA, Hoyt D et al (1996) Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop 327:191–195PubMedCrossRefGoogle Scholar
  28. 28.
    Ball CG, Kirkpatrick AW, Fox DL et al (2006) Are occult pneumothoraces truly occult or simply missed? J Trauma 60:294–298PubMedCrossRefGoogle Scholar
  29. 29.
    Exadaktylos AK, Sclabas G, Schmid SW et al (2001) Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with “normal” chest radiograph? J Trauma 51:1173–1176PubMedCrossRefGoogle Scholar
  30. 30.
    Wong YC, Ng CJ, Wang LJ et al (2004) Left mediastinal width and mediastinal width ratio are better radiographic criteria than general mediastinal width for predicting blunt aortic injury. J Trauma 57:88–94PubMedCrossRefGoogle Scholar
  31. 31.
    Ziegler DW, Agarwal NN (1994) The morbidity and mortality of rib fractures. J Trauma 37:975–979PubMedCrossRefGoogle Scholar
  32. 32.
    Palvanen M, Kannus P, Niemi S et al (2004) Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoporos Int 15:649–653PubMedCrossRefGoogle Scholar
  33. 33.
    Onuora VC, Patil MG, al-Jasser AN (1993) Missed urologicalinjuries in children with polytrauma. Injury 24:619–621PubMedCrossRefGoogle Scholar
  34. 34.
    Bochicchio GV, Napolitano LM, Haan J et al (2001) Incidental pregnancy in trauma patients. J Am Coll Surg 192:566–569PubMedCrossRefGoogle Scholar
  35. 35.
    Schurink GW, Bode PJ, van Luijt PA et al (1997) The value of physical examination in the diagnosis of patients with blunt abdominal trauma: a retrospective study. Injury 28:261–265PubMedCrossRefGoogle Scholar
  36. 36.
    Barendregt WB, de Boer HH, Kubat K (1993) Quality control in fatally injured patients: the value of the necropsy. Eur J Surg 159:9–13PubMedGoogle Scholar
  37. 37.
    West OC, Anderson J, Lee SJ et al (2002) Patterns of diagnostic error in trauma abdominal CT. Emergency Radiology 9:195–200PubMedGoogle Scholar
  38. 38.
    Guida F, Bocchin G, Chef G M et al (2010) Traumi intestinali e dei meso. Radiol med 115:S161–S165Google Scholar
  39. 39.
    Sica G, Bocchini G, Guida F et al (2010) Multidetector computed tomography in the diagnosis and management of renal trauma. Radiol med 115:936–49PubMedCrossRefGoogle Scholar
  40. 40.
    van Wessem KJ, Meijer JM, Leenen LP et al (2011) Blunt traumatic carotid artery dissection still a pitfall? The rationale for aggressive screening. Eur J Trauma Emerg Surg 37:147–154PubMedCrossRefGoogle Scholar
  41. 41.
    Miller PR, Fabian TC, Croe MA et al (2002) Prospective screening for blunt cerebrovascular injuries. Ann Surg 236:386–395PubMedCrossRefGoogle Scholar
  42. 42.
    Voeller GR, Reisser JR, Fabian TC et al (1990) Blunt diaphragm injuries. A five-year experience. Am Surg 56:28–31PubMedGoogle Scholar
  43. 43.
    Reber PU, Schmied B, Seiler CA et al (1998) Missed diaphragmatic injuries and their longterm sequelae. J Trauma 44:183–188PubMedCrossRefGoogle Scholar
  44. 44.
    Demos TC, Solomon C, Posniak HV et al (1989) Computed tomography in traumatic defects of the diaphragm. Clin Imaging 13:62–67PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Franco Guida
    • 1
  • Giorgio Bocchini
  • Giacomo Sica
    • 1
  • Anna Frezza
    • 2
  • Mariano Scaglione
    • 1
  1. 1.Department of Diagnostic Imaging“Pineta Grande” Medical CenterCastelvolturno (CE)Italy
  2. 2.Surgery Unit, “Villa delle Querce” ClinicNaplesItaly

Personalised recommendations