Missed injuries in pediatric trauma care: Still a challenge

Missed injuries (MI) in children and adolescents with multiple injuries represent a major challenge in pediatric trauma care despite the availability of standard examination protocols and imaging procedures. In the initial phase of care the primary survey is essentially important for the detection and treatment of life-threatening injuries and is well established. After stabilization of the patient in the trauma room and the first phase of treatment, a secondary survey and a tertiary survey should be carried out in order to detect initially MI in the further course and avoid longer term consequences. The majority of MI involve head, thoracic and extremity injuries. Risk factors for MI are younger patient age, the presence of multiple trauma, a higher injury severity score (ISS), a lower value on the Glasgow coma scale (GCS) and a prolonged stay in the intensive care unit. While MI are frequently described in severely or multiply injured children, a high proportion of MIs are also found in children transferred from other institutions. Therefore, two case studies from a pediatric trauma center at a maximum care hospital and a literature analysis are used to analyze typical MIs. These case examples underline the importance of adhering to a standardized treatment regimen for this patient group. It is advisable to develop a standard operating procedure (SOP) with a corresponding risk score, which regulates the tertiary survey, the times of the follow-up examinations and the corresponding (specialist) specific responsibilities.