• Jeremy D Podolnick, Daniel S Donovan, and Alfred W Atanda.
• *Department of Orthopaedic Surgery, Mount Sinai St. Luke's and Mount Sinai West, New York, NY; and †Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
• J Orthop Trauma. 2017 Sep 1; 31 (9): e281-e287.

ObjectiveDetermine the incidence of the delayed diagnosis of orthopaedic injuries in pediatric trauma patients.DesignCross-sectional retrospective analysis.SettingLevel I pediatric trauma center.Patients/ParticipantsAll patients with an orthopaedic consultation after a trauma activation with a diagnosis of fracture, dislocation, traumatic arthrotomy, neurovascular injury, amputation, and tendon or ligament injury requiring intervention. A total of 1009 trauma codes and alerts occurred during the study period, of which 196 patients were diagnosed with an orthopaedic injury.InterventionCharts were reviewed to obtain demographic information, time of presentation, Glasgow Coma Score (GCS) on presentation, injury severity score (ISS), mechanism of injury, intubation status, length of intensive care unit and hospital stay, primary and secondary survey diagnoses, discharge diagnoses, time of additional diagnoses, and reason for delayed diagnosis.Main Outcome MeasuresIncidence of delayed diagnosis of injury (DDI).ResultsThere were 196 patients with a confirmed orthopaedic injury, of which, 18 were classified as a delayed diagnosis (9.18%). The mean time to detection of injury was 77.46 hours and the mean patient age was 132.22 months. One of the 18 patients required surgical intervention while the rest were treated conservatively. The mean GCS score of patients with a DDI were significantly lower than patients without a missed injury, 12 versus 14.19 (P = 0.0009). The median ISS, 21 versus 9 (P = 0.0021), and median hospital length of stay, 4 days versus 3 days (P = 0.0369) were significantly higher for patients with a missed injury compared with those without a missed injury. The intensive care unit length of stay approached significance with a median of 2 days for patients with a missed injury versus 1 day for patients without a missed injury (P = 0.057).ConclusionsIn our study, factors that were associated with a DDI included lower GCS, higher ISS, and greater hospital length of stay. There was only 1 missed injury that required surgical intervention, and the remainder were treated conservatively. The initial evaluation of the trauma patient is able to detect life-threatening injuries, but the tertiary survey remains an important part of patient care to detect missed injuries.Level Of EvidencePrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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