Trauma; frequency of missed intra-abdominal injuries in Al-Sulaimaniyah Teaching Hospital/ Emergency Department

Background: The most common reason for injuries to be missed is altered level of consciousness due to head injury or alcohol. Other reasons include severity of injury and instability requiring immediate operation, lack of symptoms at admission, technical problems, and low index of suspicion by the examiner. Missed injuries can occur at any stage of the management of patients with major trauma. Any delay in providing the necessary treatment may lead to increased morbidity and mortality. Objective: To find the frequency of missed intra-abdominal injuries and their mortality, to raise suspicion of potential missed injuries in order to avoid these preventable deaths. Methods: A retrospective study including 2978 patients with abdominal injuries out of 13201 traumatized patients in 2006. Records were reviewed for demographics, injury characteristics, and associated injuries, missed injuries, need and indications of reoperation, morbidity and mortality. Results: The study included 2978 trauma victims; 2195 males and 783 females, with a male to female ratio of about 4:1.Thier age ranged from 2- 87 years, median age 39.5 and peak age of trauma was 31 years. From 2978 patients with abdominal injuries, there were 28 deaths (1.06%), and four missed injuries (0.134%). Conclusion: A careful history taking, precise and repeated clinical examinations, complete diagnostic procedures, complete surgical explorations, and proper timing of reoperation are necessary for patients with blunt abdominal injuries, which are cornerstones in improving the quality of trauma care.