Missed injuries in trauma associated mortalities in a Nigerian teaching hospital

Abstract

Aims and objectives: The objective of this study is to describe the pattern of missed injuries in trauma associated mortalities in the University College Hospital Ibadan Nigeria and to determine the relevance of postmortem examination in trauma related death. Subjects and methods: All cases of trauma- associated death in the Accident and Emergency Department of the University College Hospital (UCH), Ibadan Nigeria over a ten year period from January 1997 to December 2006 were reviewed. Data extracted from the records included the demographic data, the mechanism of injury, time and duration of injury prior to presentation and the clinical diagnosis. The autopsy findings were compared to the clinical diagnosis by the medical officer in the emergency department. The unrecorded injuries noted at autopsy were reviewed and classified using the modified Goldman criteria for autopsy discrepancies Results: Two hundred and ninety trauma related autopsies were performed within the stipulated period. Diagnostic errors were observed in fifty five (18.9%) of these autopsies. The commonest mechanism of injury was road traffic accident (73%). Thirty (57%) of these patients arrived at the ED within six hours of injury. There were 79 missed injuries consisting of chest injuries (43%), while 26% were abdominal injuries. There were 25 type1 and 25 type 2 major errors. The mean revised trauma score (RTS) at presentation was 4.81+/_ 1.9 with a probability of survival of >60% Conclusion Trauma care needs to be taught as a specialty. Post mortem remains a necessary quality control tool.

Keywords

• trauma
• death
• missed injuries