Evidence map›Paper›PMID 34327544›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2022

Delayed diagnosed trauma in severely injured patients despite guidelines-oriented emergency room treatment: there is still a risk.

Arnold J Suda, Kristine Baran, Suna Brunnemer, Manuela Köck, Udo Obertacke, David Eschmann

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In one paragraph

Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Article
  3. Article
  4. [Missed injuries in pediatric trauma care : Still a challenge].Unfallchirurgie (Heidelberg, Germany) · 2025
    Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Arnold J SudaDepartment of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, Academic Teaching Hospital of Paracelsus Medical University, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria. arnold.suda@auva.at.ORCID http://orcid.org/0000-0002-7194-8726
Kristine BaranDepartment of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Suna BrunnemerDepartment of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Manuela KöckDepartment of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Udo ObertackeDepartment of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
David EschmannDepartment of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeEmergency trauma room treatment follows established algorithms such as ATLS®. Nevertheless, there are injuries that are not immediately recognized here. The aim of this study was to evaluate the residual risk for manifesting life-threatening injuries despite strict adherence to trauma room guidelines, which is different to missed injuries that describe recognizable injuries.

methodsIn a retrospective study, we included 2694 consecutive patients admitted to the emergency trauma room of one single level I trauma center between 2016 and 2019. In accordance with the trauma room algorithm, primary and secondary survey, trauma whole-body CT scan, eFAST, and tertiary survey were performed. Patients who needed emergency surgery during their hospital stay for additional injury found after guidelines-oriented emergency trauma room treatment were analyzed.

resultsIn seven patients (0.26%; mean age 50.4 years, range 18-90; mean ISS 39.7, range 34-50), a life-threatening injury occurred in the further course: one epidural bleeding (13 h after tertiary survey) and six abdominal hollow organ injuries (range 5.5 h-4 days after tertiary survey). Two patients (0.07% overall) with abdominal injury died. The "number needed to fail" was 385 (95%-CI 0.0010-0.0053).

conclusionOur study reveals a remaining risk for delayed diagnosis of potentially lethal injuries despite accurate emergency trauma room algorithms. In other words, there were missed injuries that could have been identified using this algorithm but were missed due to other reasons. Continuous clinical and instrument-based examinations should, therefore, not be neglected after completion of the tertiary survey. LEVEL OF EVIDENCE: Level II: Development of diagnostic criteria on the basis of consecutive patients (with universally applied reference "gold" standard).

Indexed as

Abdominal InjuriesMultiple TraumaAdolescentAdultAgedAged, 80 and overEmergency Service, HospitalHumansMiddle AgedRetrospective StudiesTrauma CentersYoung AdultATLS®Delayed diagnosed injuryMissed injuryNumber needed to failTrauma algorithm

Identifiers

PMID34327544
PMCPMC9192381

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.