Tertiary Survey Performance in a Regional Trauma Hospital Without a Dedicated Trauma Service Gerben B. Keijzers • Don Campbell • Jeffrey Hooper • Nerolie Bost • Julia Crilly • Michael Craig Steele • Blake Eddington • Leo M. G. Geeraedts Jr. Published online: 18 August 2011 Ó Socie ´te ´ Internationale de Chirurgie 2011 Abstract Background Initial management of trauma patients is focused on identifying life- and limb-threatening injuries and may lead to missed injuries. A tertiary survey can minimise the number and effect of missed injuries and involves a physical re-examination and review of all investigations within 24 h of admission. There is little information on current practice of tertiary survey perfor- mance in hospitals without a dedicated trauma service. We aimed to determine the rate of tertiary survey performance and the detail of documentation as well as the baseline rate of missed injuries. Methods We performed a retrospective, descriptive study of all multitrauma patients who presented to an Australian level II regional trauma centre without a dedicated trauma service between May 2008 and February 2009. A medical records review was conducted to determine tertiary survey performance and missed injury rate. Results Of 252 included trauma patients, 20% (n = 51) had a tertiary survey performed. A total of nine missed injuries were detected in eight patients (3.2%). Of the multiple components of the tertiary survey, most were poorly documented. Documentation was more compre- hensive in the subgroup of patients who did have a formal tertiary survey. Conclusions Tertiary survey performance was poor, as indicated by low documentation rates. The baseline missed injury rate was comparable to previous that of retrospective studies, although in this study an underestimation of true missed injury rates is likely. Implementing a formal, institutional tertiary survey may lead to improved tertiary G. B. Keijzers Emergency Department, Gold Coast Health Service District, Gold Coast, QLD, Australia G. B. Keijzers Á M. C. Steele Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia e-mail: misteele@bond.edu.au G. B. Keijzers (&) Emergency Department, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4215, Australia e-mail: gerben_keijzers@health.qld.gov.au D. Campbell Á J. Hooper Á N. Bost Emergency Department, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4225, Australia e-mail: Don_Campbell@health.qld.gov.au J. Hooper e-mail: Jeffrey_Hooper@health.qld.gov.au N. Bost e-mail: Nerolie_Bost@health.qld.gov.au J. Crilly Emergency Department Clinical Network, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4225, Australia e-mail: Julia_Crilly@health.qld.gov.au J. Crilly Research Centre for Clinical and Community Practice Innovation, Griffith University, Gold Coast, QLD 4222, Australia B. Eddington Emergency Department, The Tweed Heads Hospital, Tweed Heads, NSW, Australia e-mail: blakee@exemail.com L. M. G. Geeraedts Jr. Department of Surgery, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands e-mail: l.geeraedts@vumc.nl 123 World J Surg (2011) 35:2341–2347 DOI 10.1007/s00268-011-1231-3