Citation

Madhusudan N, Lewis T, Kunicki A, Hardie J, Macleod I, Marsland D. Ann. R. Coll. Surg. Engl. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Royal College of Surgeons of England)

DOI

10.1308/rcsann.2021.0201

PMID

34939841

Abstract

INTRODUCTION: Previously published work has shown that there are no missed injuries following the introduction of a trauma triage clinic (TTC). This study aimed to assess both the safety and efficacy of the TTC model in a district general hospital in the United Kingdom. We aimed to assess the rate of missed 'high-risk' injuries, including posterior shoulder dislocations, talar injuries, Lisfranc injuries and complex carpal instability.

METHODS: Data were collected retrospectively between November 2017 and October 2018 (inclusive). During this time, 3,721 patients were reviewed (mean age 38 years, SD 25.5, range 1-103 years). Case notes and x-rays were reviewed for all patients. Compliance was assessed against British Orthopaedic Association Standards for Trauma (BOAST 7) guidelines for fracture clinic services. The standard for adherence to guidelines was 100%.

RESULTS: Thirty-two of 3,721 patients had a missed injury during the study period, and 66% of these injuries were high risk. TTC was effective in reducing the number of patients seen in the fracture clinic, with 23% of patients discharged directly from the TTC. Eighty-nine per cent of patients were reviewed in clinic within 72 hours of presentation, with a median time to review of 2 days.

CONCLUSION: This study has shown that TTC is efficient in reducing the burden of patients seen in the fracture clinic, but it is not as safe as reported previously. Although the prevalence of missed injuries is low, hospitals introducing a TTC model should consider departmental processes to help accurately identify and triage high-risk injuries.

Language: en

Keywords

Trauma; Guidelines; Clinical audit; Hospital outpatient clinics; Missed diagnosis