Evaluation of injury severity score of missed injuries in pediatric trauma patients at institutional adult level II trauma center: Do we need a revised National Trauma policy for pediatric trauma?

Abstract

Aims: The aim of the following study is to establish the incidence contributing factors and impact of the missed injuries in pediatric trauma patients at adult trauma center on the prognosis and overall outcome of these children. Settings and Design: Longitudinal prospective cohort study involving 603 patients in over 06 months. Materials and Methods: The relevant data (as defined) of all included patients were recorded. These patients were then followed to document the total length of hospital stay and the injury list defined at the discharge or on the 7 th day of admission; whichever came first. The injury severity score (ISS) at admission was compared with final ISS (multivariate regression analysis). Results: Total 115 (19.1%) missed injuries (adult + pediatric both) were discovered, out of which 71 (61.7%) were pediatric trauma missed injuries. The pediatric trauma missed injuries were 32.2% of all pediatric trauma patients and 11.8% of all trauma patients. Main contributing factors were incomplete assessment (52.5%) and patients' arrival time. None of the missed injuries led to any mortality, morbidity or increased length of hospitalization. Final ISS did not correlate with missed injury. Conclusions: Missed injuries are a significant problem in trauma patients especially the pediatric trauma patients. Though the majority of children with trauma were treated efficiently in the anaplastic thyroid carcinoma, but there is a need for improvement in patient assessment and monitoring, that is, extended tertiary survey; with special exposure to the attending residents at casualty about pediatric trauma and its pathophysiology.