Abstract
Background: Trauma patients admitted to the ICU are at high risk for missed injuries, particularly those with a Glasgow Coma Scale (GCS) score of less than 15. Our institution recommends that tertiary surveys be conducted within 48 hours of admission. To identify missed injuries effectively, a quaternary survey should be performed once patients have achieved neurological recovery.
Methods: We conducted a retrospective analysis of adult trauma patients admitted to a Major Trauma Centre (Level 1 equivalent) over a 2-month period. We assessed the timing and completion rates of tertiary and quaternary surveys and the detection of missed injuries. Results were presented to the trauma department, leading to the implementation of a quality improvement initiative aimed at improving the timeliness of tertiary surveys, increasing the number of quaternary surveys performed, and reducing missed injuries.
Results: Of the 127 ICU-admitted trauma patients, 98% underwent a tertiary survey; however, only 18% of these were completed within 48 hours. Tertiary surveys were conducted while patients were intubated in 10% of cases, and only 1.5% of the patients received a quaternary survey.
Conclusion: Tertiary surveys should be completed within 48 hours for trauma ICU patients. Additionally, a quaternary survey should be performed for patients with a GCS score of less than 15 after achieving neurological recovery to reduce the risk of missed injuries. Improved adherence to these practices is necessary to enhance patient outcomes.