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High delayed and missed injury rate after inter-hospital transfer of severely injured trauma patients



Missed injuries are reported in 1.3–65% of all admitted trauma patients. The severely injured patient that needs a higher level of care which requires an inter-hospital transfer has an increased risk for missed injuries. The aim of this study was to establish the incidence and clinical relevance of missed injuries in severely injured patients who require inter-hospital transfer to a level 1 trauma center.


All patients with an Injury Severity Score (ISS) ≥ 16 transferred to the University Medical Center Groningen (UMCG) between January 2010 and July 2015 were included. Data were obtained from a prospective trauma database and supplemented with information from the patient records. A delayed diagnosis was defined as any injury detected within the first 24 h after the initial trauma, with or without a tertiary survey. Missed diagnoses were defined as any injury diagnosed after 24 h following trauma.


Two hundred and fifty-one trauma patients were included. A total of 88 patients (35%) were found to have ≥ 1 new diagnoses with 65 (26%) patients that had 1 or more delayed diagnoses and 23 (9.2%) patients had 1 or more missed diagnoses (detected > 24 h after injury) after transfer to our hospital. For 47 of the 88 patients (53%), the new diagnoses required a change of management. The Glasgow Coma Scale (GCS) was the only statistically significant risk factor for a new diagnosis upon transfer.


Inter-hospital transfer of severely injured patients increases the risk of a delayed detection of injuries. We found that 35% of all transferred patients with an ISS ≥ 16 have at least new diagnoses, with over half of these diagnoses requiring a change of management. Given these findings, clinicians should maintain a high index of suspicion when receiving a transferred severely injured trauma patient.

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Correspondence to Riquard Lesley Hensgens.

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All the authors declare that they have no conflict of interest to report.

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A waiver was granted by the Medical Ethical Committee of the UMCG.

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Hensgens, R.L., El Moumni, M., IJpma, F.F.A. et al. High delayed and missed injury rate after inter-hospital transfer of severely injured trauma patients. Eur J Trauma Emerg Surg 46, 1367–1374 (2020).

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  • Trauma patient
  • Transfer
  • Delayed injuries
  • Missed injuries
  • Tertiary survey