严重多发伤误漏诊的原因分析

Reason of missed diagnosis and misdiagnosis of severe multiple trauma

目的分析多发伤误漏诊的原因及临床后果,以减少其发生率。方法对2002-12～2005-11我院收治的831例严重多发伤患者进行回顾性分析,分为漏诊组(78例)和无漏诊组(753例)进行比较。入选病例符合多发伤诊断标准,并按损伤严重程度评分(ISS)标准进行评估,所有患者ISS≥16分。结果831例患者中有78例(9.38%)漏诊。与无漏诊组比较,漏诊组患者的创伤评分较高、住院时间较长(P<0.05)。漏诊组患者格拉斯哥昏迷评分(GCS)较低,休克发生率高和死亡率高(P<0.05)。在造成78例漏诊的原因中,53.8%(42/78)与医师评估有关,这是可以避免的因素;46.2%(36/78)与患者伤情有关。结论对于严重多发伤患者应进行重复、详细、全面的体格检查,以及应有的辅助检查,保持高度警惕性,大多数漏诊是可以避免的。

Objective To analyze the reason of missed diagnosis and misdiagnosis of multiple trauma and its clinical outcome in order to reduce the incidence of multiple trauma. Methods A retro- spective analysis was made on 831 cases of severe multiple trauma from December 2002 to November 2005. The 831 cases were divided into two groups, missed diagnosis group （ n = 78 ） and non - missed diagnosis group （ n = 753 ）. The comparison was made between the two groups. All the patients satisfied with the diagnostic criteria of multiple trauma and were evaluated by Injury Severity Score （ISS） , and ISS of all the patients was~〉 16. Results There were 78 missed diagnosis cases （9. 38% ） in the 831 studied cases. Compared with the non -missed diagnosis group, ISS of cases was higher, the time of hospital stay was longer in the missed diagnosis group （ P 〈 0. 05 ）. The Glasgow Coma Score of the patients was lower, but the incidence of shock and mortality were higher in the missed diagnosis group than in the non - missed diagnosis group （ P 〈 0. 05 ）. 53.8% （ 42/78 ） missed diagnosis had something to do with the evaluation of the surgeon and thus can be avoided; 46. 2% （36/78） associated with the patient＇s condition. Conclusion Repeated and systemic physical examination and appropriate laboratory tests should be performed for cases with severe multiple trauma, and high alert for those patients should be kept in the clinical practices. Most of the misdiagnosis is avoidable.