Many factors impact healthcare professionals when managing the trauma patient. Practitioners must consider the mechanism of injury and obvious signs of trauma, as well as underlying conditions, age, potential substance abuse and other co-morbidities. An additional challenge exists when patient presentation is delayed. Numerous reasons can account for this failure to report including altered mentation, potential domestic and/or sexual abuse, economic concerns and failure to recognize the severity of the injury.
A number of standardized courses exist which support the need for practitioners to utilize a systematic approach when evaluating the trauma patient. However, even with the utilization of primary and secondary surveys, it is estimated that up to 50% of injuries, both life threatening and non-life threatening, can be missed. A number of institutions have now implemented the tertiary trauma survey (TTS) as a means of increasing the percentage of injury detection. This type of survey is conducted on multiple occasions throughout the patient’s care and includes a comprehensive approach including laboratory data and radiological findings.
Nurse practitioners and physician assistants often participate in the conduction of TSS in the hospital venue but clinicians should approach the patient presenting at the office in a similar fashion. Patients often feel more comfortable in seeking out their private physician as opposed to being seen at an emergency department and may not be aware of the severity of their injury. Blunt trauma can often be presented simply as abdominal tenderness, severe bruising may accompany extremity fractures way and altered mentation may be noticed, but not alarming, in the patient with chronic dementia. Inadequate assessments and failure to recognize subtle signs, suggestive of trauma, may result in undiagnosed injuries and serious sequellae.