Factors contributing to missed injuries in patients with trauma: Polytrauma and night-time presentation at the trauma resuscitation unit.

Abstract

In trauma care, missed injuries (MIs), defined as injuries identified during clinical reassessment involving physical examination and additional diagnostic tests, such as radiological imaging, initial and secondary surveys (these surveys are conducted according to the Advanced Trauma Life Support [ATLS] guidelines), significantly impact patient outcomes, including morbidity, mortality, and length of hospital stay. This study aimed to identify factors contributing to MIs to establish strategies for improving MI detection and care outcomes in patients from a trauma centre. This retrospective year-matched case-control study included 288 patients with trauma (144 with MIs, 144 without) admitted to a Level I trauma centre in Seoul, Korea, from 2019 to 2023. Randomly selected controls were selected using the year-match technique for temporal balance. To adjust for potential confounding, propensity score matching (1:1 nearest neighbour, calliper = 0.1) was performed separately to evaluate the independent effects of night-time presentation and polytrauma. The conditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95 % confidence intervals (CIs). Patients in the MI group had significantly longer intensive care unit and hospital stays. No significant differences were found in age, sex, GCS, or ISS between groups. Falls were the most common injury mechanism in both groups. Propensity score-matched logistic regression revealed that both night-time presentation (adjusted OR: 1.916; 95 % CI: 1.157-3.174; p = 0.012) and polytrauma (adjusted OR: 2.210; 95 % CI: 1.023-4.774; p = 0.044) were independently associated with missed injuries. Injuries were more likely to be missed in patients presenting at night or with polytrauma, with extremity injuries being the most common. These findings highlight the need to reinforce trauma team staffing, particularly during the night-time for timely evaluation and reduced MI risk. System-level strategies that improve personnel availability and promote comprehensive evaluation may enhance trauma care delivery and outcomes.