Prospective Evaluation of Missed Musculoskeletal Injuries in Trauma Prevent Study

Background

Physiotherapists are not routinely involved in tertiary survey of trauma patients but are well equipped to perform the musculoskeletal component of the tertiary survey (MSK tertiary survey) to detect any injuries that are missed during primary and secondary surveys.

Aim

To observe and evaluate MSK tertiary surveys completed by physiotherapists in the early identification of missed musculoskeletal injuries in trauma patients.

Methods

The study included a convenience sample of patients over 18 years old admitted under the Trauma team. Patients were allocated to P group if the physiotherapists conducted MSK tertiary survey before the trauma team. Patients were allocated to T group if the admitting Trauma team conducted a tertiary survey before the physiotherapists. McNemar's test was used to compare the discordance of new findings and missed injuries between the Trauma team's tertiary survey and the physiotherapists’ MSK tertiary survey within each of the groups.

Results

Two-hundred twenty-four patients were enrolled into P group and 436 patients were enrolled into T group. In the T group, 26 patients (6%) were identified with new confirmed injuries, of which physiotherapists identified 8 patients (1.9%). In the P group, 8 patients (4%) were identified with confirmed injuries, of which, physiotherapists identified 3 patients (2.4%). The discrepancies of identifying missed injuries between the trauma teams and physiotherapists in T or P group were not significant (p = 0.81, p = 0.25 respectively). No adverse events were reported.

Conclusion

Physiotherapists can conduct MSK tertiary surveys safely in the care of trauma patients as an adjunct to Trauma team-led tertiary survey to identify any missed musculoskeletal injuries in admitted trauma patients.