E1411. "The Eye Sees What the Mind is Prepared to Comprehend": An Eye Opener for Every Resident in a Trauma Setting
Authors
Chinky Patel;
University of Tennessee Health Science Center
Asif Jamal;
University of Tennessee Health Science Center
Nisha Pande;
University of Tennessee Health Science Center
Bhumin Patel;
University of Tennessee Health Science Center
Jenson Ma;
University of Tennessee Health Science Center
Muhammad Afzal;
University of Tennessee Health Science Center
Ashley Cahoon;
University of Tennessee Health Science Center
Background
Trauma is a leading cause of death worldwide. There are various mechanisms, presentations, and sequelae of acute trauma which have varying implications on patient care and outcomes. The purpose of this study is to highlight the various presentations of acute traumatic findings that can affect all organ systems, which every resident should be aware of before working in a trauma setting. The focus of the exhibit is to present examples of areas that are easily overlooked and findings that are commonly missed. The exhibit includes factors that can further contribute to errors in reporting, such as underreading, satisfaction of search, satisfaction of report, faulty reasoning, and missed findings due to abnormalities lying outside the area of interest. Possible strategies to minimize these errors will also be highlighted.
Educational Goals / Teaching Points
A combination of factors can contribute to errors in reporting, which when coupled with reporting in more challenging situations such as a trauma center can further add to delays in diagnosis. A thorough search strategy helps avoid common misses, improving efficiency in a busy trauma setting. Recognizing various patterns and mechanisms of injury makes a difference in the approach to reporting. Overall, this leads to prompt communication with the trauma team and improved patient care and outcomes.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will present a variety of multisystem acute traumatic injuries across all modalities. Organ-based injuries will be evaluated predominantly on CT with arterial and delayed phase imaging. Dual-phase CT is also crucial for identifying active bleed and pseudoaneurysms, which are common sequelae of acute vascular injury. Plain radiographs, CT, and MRI will be utilized for the demonstration of musculoskeletal trauma. Individual findings for each system will be presented on a certain modality with optimal windowing techniques to better visualize these features.
Conclusion
Working in a trauma center can be intimidating for residents in training, especially when there is a wide range of possible findings that can affect every organ system. This exhibit highlights the various presentations of acute trauma, focusing on findings that can be easily missed. This exhibit provides a basic foundation for residents to understand the importance of an efficient yet complete systematic approach to search for findings based on knowledge of common mechanism-based injury patterns. Diagnostic errors are responsible for approximately 10% - 15% of preventable deaths in trauma center audits. Delays in diagnosis may occur when the trauma team is not alerted to important traumatic findings. The end goal is to ensure that imaging findings are communicated to the patient's care team in a timely manner. Early diagnosis is essential for limiting mortality and disability, which are common long-term trauma outcomes.
