[Injuries missed in diagnosing severely injured accident victims in the emergency room].

OBJECTIVE To determine the incidence of injuries missed in the emergency room (ER) and the factors involved. DESIGN Retrospective. METHOD Of patients with an Hospital trauma index-injury severity score (HTI-ISS) > or = 14 who were treated in 1996 in the ER of the Academic Hospital Utrecht, the Netherlands, it was studied in the computerized database whether injuries had been missed. A missed injury was defined as an injury not identified during assessment in the Emergency department, but identified later in the hospital or rehabilitation centre. The groups of patients with and without missed injuries were compared with each other regarding possible risk factors for missing injuries. RESULTS Of 376 severely injured patients in 1996, 329 patients had sufficient follow-up documentation. In 37 patients (11%) of these 329 patients 47 injuries were missed. Fractures were the injuries most frequently missed (n = 25), followed by nerve tissue injuries (n = 14). There were consequences for the treatment in 13 of these patients (35%). Patients with missed injuries had a higher HTI-ISS, were more often primarily referred to the ER and arrived more often at night compared with patients without missed injuries. The two patient groups did not differ at to experience of the physicians.