Improving Trauma Care: Modified Tertiary Survey for Patients with Head Injuries
Janssen, G., Auckland District Health Board, Auckland, New Zealand O’Sullivan-Scott, J., University of Auckland, Auckland, New Zealand Cameron, N., University of Auckland, Auckland, New Zealand Civil, I., Auckland District Health Board, Auckland, New Zealand
Introduction: Tertiary surveys in our unit identify undetected injuries in up to 25% of patients. A review of our clinical practice has highlighted that patients with significant head injuries are less likely to receive a tertiary survey. This is often due to patient factors that hinder a thorough examination. We hypothesized that the use of a targeted tertiary survey tool specific to patients with a head injury would be non-inferior to a standard tertiary survey, and easier for clinicians to implement.
Aims: To analyze the efficacy and ease of use of a modified tertiary survey tool for patients with a head injury.
Methods: Patients who met the criteria for a tertiary survey and had a head injury were assessed using both the standard tertiary survey and the modified tertiary survey tool. Detection of injuries, time taken to complete a survey, and feedback from clinical staff were recorded.
Results: 10 patients met the criteria for study enrollment between February and April 2021. The mean AIS head score was 2.9. Undetected injuries were detected in 10% of patients on the standard tertiary survey and in 40% of patients on the modified tertiary survey. 100% of these injuries were clinically significant requiring further investigation or treatment. The mean time to complete the standard tertiary survey was 30.6 minutes vs 17 minutes for the modified tertiary survey.
Conclusions: Patients with head injuries are more likely to miss out on a tertiary survey and are therefore more likely to have injuries go undetected. A modified tertiary survey designed for patients with head injuries is more effective than a standard tertiary survey for detecting missed injuries. The modified tertiary survey is easier and faster for the clinicians to implement, and therefore clinicians are more likely to complete them.