The Tertiary Survey as a Quality Improvement Initiative in Pediatric Trauma Care.
Document Type
Article
Publication Date
5-9-2023
Publication Title
American Surgeon
Keywords
patient satisfaction, pediatric trauma, performance improvement, quality outcomes, trauma tertiary surgery.
ISSN
1555-9823
Abstract
BACKGROUND: Patients are at risk of missed or delayed injuries in the setting of multisystem trauma, which may be identified with a tertiary trauma survey (TTS). There is limited literature to support the utilization of a TTS in pediatric trauma population. We aim to assess the impact of the TTS as a quality and performance improvement tool in identifying missed or delayed injuries and improving the quality of care among pediatric trauma population.
METHODS: A retrospective study assessing a quality improvement/performance improvement (QI/PI) project focusing on the administration of tertiary surveys to pediatric trauma patients was conducted at our level 1 trauma center between 08-2020 and 08-2021. Patients with injury severity scores (ISS) greater than 12 and/or an anticipated hospital stay greater than 72 hours met inclusion criteria and were included.
RESULTS: Of the 535 trauma patients admitted to the pediatric trauma service during the study period, 85 (16%) patients met the criteria and received a TTS. Thirteen unaddressed or undertreated injuries were found in 11 patients: 5 cervical spine injuries, 1 subdural hemorrhage, 1 bowel injury, 1 adrenal hemorrhage, 1 kidney contusion, 2 hematomas, and 2 full thickness abrasions. Following TTS, 13 patients (15%) had additional imaging, which identified 6 of the 13 injuries.
CONCLUSION: The TTS is a valuable quality and performance improvement tool in the comprehensive care of trauma patients. Standardization and implementation of a tertiary survey have the potential to facilitate the prompt detection of injuries and improve the quality of care for pediatric trauma patients.
LEVEL OF EVIDENCE: III.
NSUWorks Citation
Ulloa, Emily; Archie, Jessica; Selvakumar, Sruthi; Levy, Marc; Elkbuli, Adel; and Plumley, Donald, "The Tertiary Survey as a Quality Improvement Initiative in Pediatric Trauma Care." (2023). HPD Articles. 437.
https://nsuworks.nova.edu/hpd_facarticles/437
DOI
10.1177/00031348231175111
