Hidden Injuries in Emergency Care: What the Emergency Room Did Not See Coming

Missed injuries in emergent care and trauma settings detrimentally affect patient outcomes, prolonging hospitalization, delaying treatment, and even increasing mortality risk. Despite standardized trauma protocols, injuries can escape detection during the initial evaluation. Our objective in this article is to review clinical factors that may be associated with missed injury rates in patients. This could possibly identify patterns that may help develop future prevention methods and subsequent improvements in emergency care. A targeted literature review of 14 peer-reviewed studies evaluating unrecognized injuries was conducted. Factors analyzed include patient incapacitation measured using the Glasgow Coma Score (GCS), interhospital transfer, patient's sex, physician training level, and location. Our findings indicated that junior physicians accounted for most reported and overlooked injuries compared with intermediate- and senior-physicians, demonstrating that limited clinical experience may adversely affect patient outcomes. Interhospital transfer was also associated with increased rates of undiagnosed injuries, possibly due to disjointed care, poor communication, or documentation inconsistencies. Surprisingly, patient incapacitation was not associated with increased missed injury rates. Upper extremity injuries, especially those involving the hand and wrist, were the most commonly overlooked injuries, followed by lower extremity injuries. The country of medical care did not appear to relate to differences in undiagnosed injury rates. It is the authors’ belief that missed injuries are a persistent challenge in trauma care and seem to relate mostly to the healthcare system rather than patient factors. Stronger interhospital transfer systems, improved physician training, and standardized tertiary physical evaluations could help improve patient outcomes. Future research should include more large-scale studies, as this review included only 14 articles.