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Table 1 Description of included studies

From: The effect of tertiary surveys on missed injuries in trauma: a systematic review

Author, year, origin Population (number and description) Population characteristics (Age, Gender, Mechanism, ISS) Intervention Outcome measure Study design
Enderson, 1990, Tennessee, USA 399 admitted trauma patients Age>15 yrs: 86% TTS as part of trauma admission form, conducted within 24–48 hours after patient stabilization Missed injuries – defined as detected as a result of TTS. (Type I) Prospective cohort study – comparing with historical summary data
Gender: N/A
Mechanism: 89%
Blunt Mean ISS: 21
Biffl, 2003 All admitted trauma patients. Mean Age: 45.3 vs. 44.5 yrs Implementation of formal TTS, using standardized form and TTS policy. TS within 24 hours and after ICU discharge Missed injury rate – defined as injuries detected after 24 hours admission or injuries missed by TTS. (Type II) Cohort study with before-and-after design
Rhode Island, USA Before: 3,412 Gender: 63% vs. 64% Male
After: 3,442 Mechanism: N/A
Mean ISS: 10.7 vs. 10.7
Vles, 2003 All (3,879) admitted trauma patients Age: N/A Use of standard trauma forms, TTS and review of radiology within 24 hours Missed injury rate – Any injury missed on primary and secondary survey. (Type I) Prospective cohort study
The Netherlands Gender: N/A
Mechanism: N/A
ISS>16: 1.2%
Hoff, 2004 432 admitted trauma patients Age: N/A Formal radiology rounds as part of TTS Missed injury or ‘new diagnosis’ as result of radiology rounds with trauma surgeons. (Type I) Prospective cohort study
Pennsylvania, USA Gender: N/A
Mechanism: N/A
ISS: N/A
Soundappan, 2004 76 children admitted with ISS>9 Mean Age: 8.5 yrs TTS performed using standardized from by trauma fellow on day after admission and after extubation Missed injury rate – Any injury missed on primary and secondary survey. (Type I) Prospective cohort study
Sydney, Australia Gender: 66% Male
Mechanism: 100% Blunt
Mean ISS: 15
Howard, 2006 90 admitted trauma patients Age: N/A TTS performed using standardized from by single clinician within 24 hours Missed injury rate – Any injury detected on the TTS. (Type I) Prospective cohort study
Indianapolis, USA Gender: 74% Male
Mechanism: N/A
ISS: N/A
Okello, 2007 403 admitted trauma patients Mean Age: 29 yrs Daily physical examination up to 30 days, including TTS in first 24 hours Missed Injury – unclear definition – implied as injury detected after primary and secondary survey. (Type I) Prospective cohort study
Uganda Gender: 82% Male
Mechanism: 91% Blunt
ISS: N/A
Janjua, 2008 206 admitted trauma patients Mean Age: 35 yrs TTS performed by trauma fellow within 24 hours and after regaining consciousness Missed injury rate – Any injury missed on primary and secondary survey and operating room. (Type I) Prospective cohort study
Sydney, Australia Gender: 75% Male
Mechanism: 91-100% Blunt
ISS: N/A
Ursic, 2009 All admitted trauma patients. Mean Age: 43.4 vs. 44.4 yrs Gender: 69.4% vs 68.9% Male Mechanism:94.3 vs. 94.4% Blunt ISS>15: 26% vs 31% Implementation of a dedicated trauma service, which included a formalised TTS Mortality and Length of Hospital stay. Missed injury – not in article -data retrieved via author communication - any injury missed at primary and secondary survey. (Type I) Cohort study with before-and-after design
Sydney, Australia Before: 981
After: 1,006
Huynh, 2010 5,143 admitted trauma patients Mean Age: 36.2 yrs Mid level providers performed TTS using a form within 48 hours. This was reviewed by trauma surgeon Missed injury – defined as detected at TTS. (Type I) Prospective cohort study
North Carolina, USA Gender: 71% Male
Mechanism: 85% Blunt
Mean ISS: 14.2
  1. ISS Injury Severity Score, TTS Tertiary Survey, USA United States of America.