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Missed Injuries and Unplanned Readmissions in Pediatric Trauma Patients

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Missed Injuries and Unplanned Readmissions in Pediatric Trauma Patients
Pamela M. Choi, MD, Jennifer Yu, MD and Martin S. Keller, MD, St. Louis Children's Hospital, St. Louis MO

Background: We sought to determine the incidence and characteristics of missed injuries and unplanned readmissions at a Level-1 pediatric trauma center. Methods: We conducted a retrospective review of all trauma patients who presented to our ACS-Verified Level-1 pediatric trauma center from 2009-2014. Results: Overall, there were 27 readmissions and 27 missed injuries (0.38%). Patients who were unplanned readmissions had a greater Injury Severity Score (ISS) (8.6 vs 5.2, p=0.03), had longer hospitalizations (4.9 vs 2.5 days, p=0.02), and were more likely to have required operative intervention (51.9% vs 32.3%, p=0.04). The average length of stay for the 2nd admission was 5.1 days, and 37% of these patients required surgery. Similarly, patients identified with missed injuries had a higher ISS (15.2 vs 5.2, p Background: We sought to determine the incidence and characteristics of missed injuries and unplanned readmissions at a Level-1 pediatric trauma center. Methods: We conducted a retrospective review of all trauma patients who presented to our ACS-Verified Level-1 pediatric trauma center from 2009-2014. Results: Overall, there were 27 readmissions and 27 missed injuries (0.38%). Patients who were unplanned readmissions had a greater Injury Severity Score (ISS) (8.6 vs 5.2, p=0.03), had longer hospitalizations (4.9 vs 2.5 days, p=0.02), and were more likely to have required operative intervention (51.9% vs 32.3%, p=0.04). The average length of stay for the 2nd admission was 5.1 days, and 37% of these patients required surgery. Similarly, patients identified with missed injuries had a higher ISS (15.2 vs 5.2, p<0.0001), greater length of stay (12.7 vs 2.5 days, p<0.0001), and were also more likely to be intubated (25.9% vs 3.6%, p <0.0001) or require critical care (48.1% vs 10.3%, p<0.0001). Seven missed injuries were in patients who were deemed non-accidental trauma (25.9%) and significantly altered their hospital course while 10 patients (37%) required operative intervention or a procedure requiring sedation. Conclusions: Missed injuries and unplanned readmissions were rare occurrences among our pediatric patient population. These events, however, result in longer hospitalizations and additional procedures. Patients with multisystem injuries and compromised physical exam are at higher risk.

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Objective: Identify the risk factors and consequences of missed injuries and unplanned readmissions in pediatric trauma patients.

Objective Content: Patients with higher injury severity scores are at higher risk for both missed injuries and unplanned readmissions. These patients also have longer hospitalizations. However, despite restrictive imagining practices at our institution, missed injuries and unplanned readmissions were rare.


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