多发伤的漏诊分析

Analysis of missed diagnosis in patients with multiple trauma

目的分析多发伤患者漏诊的原因并探讨其预防对策,以降低漏诊的发生率。方法对2008年1月～2009年12月本院收治的207例多发伤患者进行回顾性分析,分为漏诊组(26例)和无漏诊组(181例)进行比较。结果 207例患者中有26例漏诊(12.56%)。与无漏诊组比较,漏诊组患者ICU治疗时间、住院时间长、创伤评分(ISS)、死亡率较高(P<0.05)。造成漏诊的原因以患者意识障碍无法提供病史、医师评估不充分、患者生命体征不稳定无法进一步检查有关。结论对多发伤患者特别应防止发生脊柱、胸腹部等部位重大漏诊,而使患者致残或失去抢救机会。努力避免主观因素,规范、反复的创伤评估,是减少多发伤早期诊断时漏诊的关键。

Objective To analyze the causes of missed diagnosis in patients with multiple trauma and to discuss the prevention countermeasures of missed diagnosis.Methods There were 207 cases of multiple trauma patients admitted to our hospital from January 2008 to December 2009,including 26 cases of missed diagnosis and 181 cases without missed diagnosis.All data were retrospectively analyzed.Results There were 26 cases of missed diagnosis in all 207 patients（12.56%）.Compared with the patients without missed diagnosis,the ICU stay time,the length of hospital stay,ISS score,mortality of patients with missed diagnosis were higher（P0.05）.The missed diagnosis was relevant to patients disturbance of consciousness which results in incomplete paitent history,inappropriate triage for patitents by doctors,unstable vital sign of patients which causes difficulty of further examinations.Conclusion The major missed diagnosis of the spine,thorax and abdomen of the patients with multiple trauma should be avoided,otherwise it will lead to patients＇ disability or death.The key to reduce the missed diagnosis in early stage is trying to avoid subjective factors and to practise standard,repeatedly trauma evaluation.