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Citation
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Gonçalves AC, Parreira JG, Gianvecchio VAP, Lucarelli-Antunes PDES, Pivetta LGA, Perlingeiro JAG, Assef JC. Rev. Col. Bras. Cir. 2022; 49: e20223319. |
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Abstract
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OBJECTIVE: to assess the role of autopsy in the diagnosis of missed injuries (MI) and definition of trauma quality program goals.
METHOD: Retrospective analysis of autopsy reports and patient's charts. Injuries present in the autopsy, but not in the chart, were defined as "missed". MI were characterized using Goldman's criteria: Class I, if the diagnosis would have modified the management and outcome; Class II, if it would have modified the management, but not the outcome; Class III, if it would not have modified neither the management nor the outcome. We used Mann-Whitney's U and Pearson's chi square for statistical analysis, considering p<0.05 as significant.
RESULTS: We included 192 patients, with mean age of 56.8 years. Blunt trauma accounted for 181 cases, and 28.6% were due to falls from the same level. MI were diagnosed in 39 patients (20.3%). Using Goldman's criteria, MI were categorized as Class I in 3 (1.6%) and Class II in 11 (5.6%). MI were more often diagnosed in the thoracic segment (25 patients, 64.1% of the MI). The variables significantly associated (p<0.05) to MI were: time of hospitalization < 48 h, severe trauma mechanism, and not undergoing surgery or computed tomography. At autopsy, the values of ISS and NISS were higher in patients with MI.
CONCLUSION: the review of the autopsy report allowed diagnosis of MIs, which did not influence outcome in their majority. Many opportunities of improvement in quality of care were identified.
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