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Objectives and questions: Delayed diagnosed injuries (DDI) remain a challenge in multiple trauma patients as they can lead to prolonged recovery time and irreversible damage. Thus, it can be crucial to diagnose initially missed injuries as early as possible. Previous studies have introduced parameters that can influence the risk of diagnosing injuries after the initial admission. This study aims at validating these findings and introducing novel aspects to identify DDIs more efficiently.

Material and methods: All Patients who were primarily admitted via the trauma bay between 2023 and 2026 and received a tertiary survey examination by our staff were analyzed. We described patients’ characteristics, trauma mechanisms, injury patterns, timing of operations and circumstances of tertiary survey examinations to identify the prevalence and characteristics of DDIs and analyze how to identify DDIs more efficiently.

Results: 673 patients were admitted via the trauma bay in our department since 2023 and received a formal tertiary survey examination. This interim analysis consists of 95 patients and the prevalence of DDIs was 11% (n=10). All patients with DDIs had multiple injuries of least three injured body parts (100% vs. 28%, p <0.01) while we did not find any differences regarding the trauma mechanism, age or GCS at admission. DDIs consisted of injuries of the extremities or non-dislocated fractures of the sternum, pelvis or skull. 70% of DDIs needed surgical interventions. Patients with injuries diagnosed after the tertiary survey examination were significantly more likely to undergo surgical emergency interventions on the day of admission (80% vs. 27%, p = 0.027).

Discussion and conclusions: Knowing contributing factors for DDIs is the first step to identifying patients at risk. This interim analysis found, as previously described, that trauma patients with more than three body parts affected are more likely to have DDIs. Furthermore, surgical interventions on the day of admission seem to present a risk factor for missing injuries during the tertiary survey examination and therefore delaying adequate treatment. Repeating the tertiary survey for patients with a high-risk profile for DDIs at different time points might help to lower the rate of missed injuries in polytrauma patients.