摘要
目的 探讨多发伤漏诊的原因以及所产生的临床后果 ,以减少其发生率。 方法对 1996年 1月～ 2 0 0 2年 12月我院收治的 6 89例多发伤患者进行回顾性分析 ,分为漏诊组 (5 6例 )和无漏诊组 (6 33例 )。两组数据进行比较和统计学分析 ,以确定漏诊的发生率 ,引起漏诊的原因以及漏诊所产生的临床后果。 结果 6 89例患者中有 5 6例 (8.1% )漏诊。与无漏诊组比较 ,漏诊组患者的创伤评分较高 ,住院时间和ICU治疗时间较长 (P <0 .0 5 )。漏诊组患者格拉斯哥昏迷评分 (GCS)较低 ,使用镇静剂的比例 (2 6 .8% )明显增高 (P <0 .0 5 )。在造成 98例次漏诊的原因中 ,5 6 .1% (5 5 / 98)与医师评估有关 ,是可以避免的因素 ;4 3.9% (43/ 98)与患者伤情有关。 结论合并早期神经系统损害的严重损伤患者容易出现漏诊 ,并且会加重患者病情。通过重复临床评估和保持高度警惕性 ,大多数漏诊是可以避免的。
Objective To explore the causes and clinical outcomes of missed injuries in patients with multiple trauma so as to minimize their incidence. Methods A retrospective study was conducted in 689 trauma patients admitted into our hospital from January 1996 to December 2002 which were divided into missed injury group ( n =56,Group A) and non-missed injury group ( n =633,Group B). Medical data were compared and statistically analyzed to identify the incidence,the contributing factors,and the clinical outcomes of the missed injuries. Results Of 689 patients,56 (8.1%) had missed injuries. Patients in the Group A had higher mean Injury Severity Scores,longer inpatient stay and longer treatment time in the intensive care unit compared with that in the Group B ( P <0.05). Patients with missed injuries were more likely to have lower Glasgow Coma Scale scores with increased percent (26.8%) of pharmacologic paralysis ( P <0.05). Of the factors contributing to 98 cases/times of missed injuries,56.1% (55/98) closely related to the evaluation by the doctors and were potentially avoidable,and 43.9% (43/98) were associated with the severity of the injuries. Conclusions The patients with severe injury complicated by initial neurological damage are not only apt to missed injuries,but also result in severer injuries. The majority of missed injuries are potentially avoidable through repeat clinical assessments and a high index of awareness.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2004年第6期343-346,共4页
Chinese Journal of Trauma
关键词
多发伤
漏诊
创伤
临床资料
Multiple trauma
Diagnosis
Missed injuries
