• S V S Soundappan, Andrew J A Holland, and Daniel T Cass.
• Children's Hospital at Westmead, Sydney, Australia.
• J Trauma. 2004 Jul 1;57(1):114-8; discussion 118.

BackgroundThere are limited data on the incidence of delayed diagnosis of injuries in children. We sought to investigate the role of an extended tertiary survey in pediatric trauma patients.MethodsAll children that were admitted to The Children's Hospital at Westmead with an Injury Severity Score (ISS) >/= 9 were included in the study. The trauma fellow performed the tertiary survey the day after admission. This was repeated after extubation in ventilated patients and in head injury patients when they were more mobile and cooperative.ResultsSeventy-six patients satisfied the criteria for the study (50 boys and 26 girls). Age ranged from 1 month to 15 years. The median ISS was 14. Sixteen (16%) of the patients had missed injuries, of which skeletal injuries were the most common (10 of 12). Delayed diagnosis of injury occurred most frequently in children involved in motor vehicle injuries. Sixty-six (66%) of the injuries were detected within the first 24 hours. Inadequate assessment and head injury were the most common contributing factors.ConclusionThe incidence of missed injury (16%) in our study was comparable to reported figures in the adult literature. There was no correlation between missed injuries and intensive care unit stay or ISS. Head injury often delayed diagnosis and thus ongoing evaluation in this group is recommended. Missed injuries did not result in mortality, but there was significant associated morbidity. A tertiary survey should be part of the evaluation of the pediatric trauma patient.

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