• R A Lichtveld, A T E Spijkers, I F Panhuizen, H R Holtslag, and Chr van der Werken.
• Stichting Regionale Ambulance Voorziening Utrecht, Bilthoven. r.lichtveld@ravu.nl
• Ned Tijdschr Geneeskd. 2006 Oct 7;150(40):2197-202.

ObjectiveTo determine the background and consequences of failing to diagnose injuries in prehospital care.DesignProspective cohort study.MethodData were collected from 507 trauma patients with multiple injuries, and a Hospital trauma index-injury severity score of 16 or higher, who were delivered by the emergency ambulance service to the emergency department of the University Medical Centre Utrecht, the Netherlands, in 1999-2000.ResultsThe percentage of missed injuries varied from 9-55. For every additional year of age the risk of missing thoracic injuries was 2% higher. The risk of missing head injuries was 84% lower in people with a Triage revised trauma score (T-RTS) < 11. Initially missing an injury had no consequences for duration of stay in the ICU except in those patients with injuries to the lower extremities. A difference in quality of life was only reported for patients in whom injuries ofthe ribs, shoulder or clavicle had been missed. For every year of age, there was a 2% greater risk of dying within 1.5 years. A T-RTS < 11 resulted in a 5.6-fold greater risk of death. Failing to diagnose an injury did not in itself increase the risk of death.ConclusionFrequently missing an injury prior to hospitalization did not result in a poorer chance of survival or lesser quality of life. The risk of dying was mainly related to a higher age and a poorer general condition at the scene of the accident. According to these findings there is no reason to adapt the current policy with regard to initial care and transport of trauma patients.

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