Delayed diagnosis of injury in pediatric trauma

Objective. To define the frequency and nature of delayed diagnosis of injury (DDI) in pediatric trauma. Design. Retrospective review. Setting. Tertiary pediatric trauma center. Methods. Medical records of 1175 pediatric trauma admissions from July 1, 1989, through June 30, 1992, were reviewed. Results. Fifty (4.3%) patients had 53 DDI. Fractures accounted for 38 DDI, most commonly of the extremities (total, 16). The delay until injury diagnosis ranged from 1 to 55 (median, 3) days. Patients with DDI had lower scores on the Glasgow Coma Scale, higher injury severity scores, and longer pediatric intensive care unit and hospital stays than patients without DDI. Patients with DDI more frequently required medical transport, emergent intubation, admission to the pediatric intensive care unit, and surgery. The DDI altered treatment for 68% of patients; 10 required surgery, including second operations for 6 children. Conclusions. DDI represents a failure of pediatric trauma care at all levels. The severely injured child is at the greatest risk of DDI. All pediatric patients with trauma warrant ongoing evaluation to identify initially unrecognized injuries.