Main Causes of Diagnostic Errors in Spleen Injury in Trauma Centers of Various Levels

RELEVANCE Despite a sufficiently large number of works, spleen ruptures at closed abdominal traumas are among the most frequent pathology that a surgeon has to face in emergency surgery.

THE AIM OF STUDY To analyze the frequency of diagnostic errors in trauma centers of different levels and to outline the ways of their reduction.

MATERIAL AND METHODS The study presents the analysis of treatment of 360 victims with closed abdominal injuries accompanied by spleen rupture, who were treated in medical institutions of the Saratov region in the period from 2003 to 2023. The average age of the injured was 34 [28; 40] years. Medical care of the injured was provided in level I–III trauma centers. All patients were divided into two groups: A — assistance at the prehospital stage was provided by ambulance brigades and B — assistance was provided by non-medical workers.

RESULTS The conducted study shows that the number of diagnostic errors in closed spleen injuries depends on the level of the trauma center. The lowest number of diagnostic errors was observed in level I trauma centers, 5.8% of cases, whereas in level II trauma centers, 32.8% (r=0.86, p<0.05), and in level III trauma centers, 35.7% (r=0.88, p<0.05), i.e., the highest number of diagnostic errors. The reasons that led to the delay in surgical intervention for such injuries can be emphasized as follows: diagnostic errors — in 5.8% of observations in level I trauma centers, in 11.8% of cases in level II trauma centers (r=0.76, p<0.05) and in 35.7% of observations in level III trauma centers (r=0.84, p<0.05); medical errors were absent in level I trauma centers, in 7.8% of cases in level II trauma centers (r=0.67, p<0.05), and in 28.5% of observations in level III trauma centers (r=0.87, p<0.05); concealment of injury or difficulty in diagnosis due to alcohol intoxication — in level I trauma centers — in 2.7% of cases, in level II trauma centers — in 13.1% of observations (r=0.87, p<0.05), in level III trauma centers — none.

CONCLUSION The conducted study has shown that the prevalence of diagnostic errors in level III trauma centers might be the result of organizational problems and the lack of diagnostic equipment and/or the absence of a profile specialist who can perform additional diagnostic tests, especially at night.

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