Risk factors for initially missing injuries in severely injured children and adolescents: a retrospective study from the traumaregister DGU

TL;DR

This study identifies risk factors for initially missed injuries in children and adolescents, which can lead to longer hospital stays.

Contribution

The study identifies specific risk factors for delayed diagnosed injuries in pediatric trauma patients using a large trauma registry.

Findings

Patients with more diagnoses and higher injury severity scores are at higher risk for initially missed injuries.

Treatment at level-2 or -3 trauma centers increases the likelihood of missed injuries in children and adolescents.

Missed injuries lead to longer intensive care unit stays compared to those without missed injuries.

Abstract

Injuries diagnosed after the emergency department period are a significant challenge to trauma care, since these delayed diagnosed injuries (DDI) may require specific additional treatment. The aim of this study was to obtain an overview of DDI in children and adolescents and to meticulously analyze the underlying reasons leading to initially missing injuries by evaluating data from the TraumaRegister DGU. TraumaRegister DGU data from the years 2010 to 2021 were evaluated. All patients up to the age of 20 were included. Patients older than 20 years of age and patients who died in the trauma room were excluded. All injuries diagnosed after the trauma room period were included in the statistics and defined as DDI, since we focus on the initial care phase and stress that injuries can be overlooked initially, but should be discovered during in hospital treatment. A total of 12,733 patients were included in this study, of whom 68.5% were male. In 1,246 patients (9.8%), at least one diagnosis was a DDI. Patients with DDI had an average age of 15.1 ± 5.3 years and had a longer stay in the intensive care unit with 9.4 ± 11.6 days than those without an initially missed injury (no-DDI) with 5.6 ± 9.1 days. The DDI-group’s mean ISS was 24.0 ± 14.5 and thus substantially higher than the mean ISS in the no-DDI group (17.5 ± 12.2). Independent risk factors for DDI were number of diagnoses per patient (OR 1.19; CI 1.16–1.22, p < 0.001), hospital level 2/3 (OR 1.89; CI 1.61–2.22, p < 0.001), relevant (AIS ≥ 2) injuries to the abdomen (OR 1.23; CI 1.06–1.42, p = 0.006) or lower extremities (OR 1.25; CI 1.08–1.43, p = 0.002). The present study demonstrates that injuries in pediatric and adolescent trauma patients are frequently missed initially during the context of trauma room treatment and diagnostics. These DDIs have an impact on the length of hospital and intensive care unit stay. We identified risk factors for DDI, i.e. higher numbers of trauma diagnoses, a higher injury severity score and treatment in level-2 or -3 trauma centers.

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