Delayed diagnosis of injuries in total-body CT scanning during the initial assessment after severe trauma

Abstract text (incl. references and figure legends)

Introduction: Despite the existence of the ATLS- and other diagnostic guidelines for the initial assessment of trauma patients, injuries can still be missed and/or diagnosed with delay. The aim of this study was to quantify delayed diagnosed injuries during the initial assessment of trauma patients using a total-body CT (TBCT)-scan in a Level 1 Trauma Center in the Netherlands.

Methods: We conducted a retrospective cohort study of all trauma patients who were assessed in the trauma room of the Amsterdam University Medical Center (AUMC), location AMC, using a TBCT-scan between January 2017 and December 2020. A delayed diagnosed injury was defined as an injury sustained during the initial trauma and not discovered nor suspected upon admission to the Intensive Care Unit (ICU) or nursery ward following the initial assessment, diagnostic studies, or surgery. To identify variables associated with delayed diagnosis, the Wald test for a univariate logistic regression was performed.

Results : In total, 697 trauma patients with a median age of 46 years (IQR 30-61) and a median Injury Severity Score (ISS) of 16 (IQR 9-25) were included. Delayed diagnosed injuries were found in 97 patients (13.9%). Forty-eight of the delayed diagnosed injuries (49.5%) were within the TBCT-scanned area. Ten delayed diagnosed injuries had an Abbreviated Injury Scale (AIS) score of ≥3. Most injuries were diagnosed before or during the tertiary survey (60.8%). The median time of delay was 34,5 (IQR 17.5 – 157.25) hours. Variables associated with delayed diagnosis were primary ICU admission (OR 1.986, p=0.003), an ISS ≥16 (OR 1.579, p = 0.042), and 40+ days of hospitalization (OR 8,500, p = 0.000).

Conclusion: Delayed diagnosed injuries in patients after severe trauma are unavoidable despite the use of a TBCT-scan, especially in multi trauma patients. A close follow-up and a high suspicion of delayed diagnosed injuries within multi trauma patients assessed with a TBCT-scan remains mandatory.

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