To observe and evaluate a tertiary survey completed by physiotherapists in the early identification of missed musculoskeletal injuries in trauma patients.
This prospective evaluation study included a convenient sample of patients aged over 18 years admitted under Trauma teams at Liverpool Hospital. Fourteen physiotherapists including weekday and weekend staff volunteered to participate in the study and performed tertiary surveys on all patients enrolled in the study. Patients whose tertiary surveys were conducted by physiotherapists prior to the Trauma team were enrolled into the ‘P’ group. Patients whose tertiary surveys were conducted by the Trauma team before physiotherapists were enrolled into the ‘T’ group. McNemar’s test was used to compare the discordance of new findings at the tertiary survey and missed injuries between the Trauma team and physiotherapists within each of the groups.
There were 1929 patients who were admitted under the Trauma team from January 2014-January 2015; 224 patients were enrolled into P group, and 436 patients were enrolled into T group. There were no significant between-group differences in patient demographics. Twenty-six patients (6%) were identified with confirmed injuries in the T group where Physiotherapists identified 8 new injuries (1.9%) in 8 patients where the Trauma team had not identified new injuries. The discrepancy between teams was not statistically different (p=0.81). Eight patients (4%) were identified with confirmed injuries in the P group where Physiotherapists identified 3 new injuries (2.4%) in 3 patients where the Trauma team had not identified new injuries. The discrepancies between the teams were not significant (p=0.25). Missed injuries identified by physiotherapists in the T group included fractures of the acromion, radius, ulna, scaphoid, fibula, tibia, great toe, metatarsal and supraspinatus tear. Missed injuries identified by physiotherapists in the P group included fractures of the ilium, acetabulum, naviculum, thumb and a medial collateral ligament tear. No adverse events were reported.
This study demonstrated the successful, safe implementation and feasibility of a physiotherapist-led tertiary survey in identifying missed musculoskeletal injuries in admitted trauma patients. While the data presented in our study are from an earlier period, our study findings are novel and continue to hold significant relevance as tertiary survey by physiotherapists is not routine. Physiotherapy-led tertiary survey may be worthwhile and beneficial in the care of the trauma patients as an adjunct to Trauma team-led tertiary survey.
It is feasible and safe for physiotherapists to conduct tertiary survey in identifying any missed musculoskeletal injuries in trauma patients.
Tertiary survey may be considered and incorporated as a component of physiotherapy initial assessment for trauma patients.
Trial ID: ANZCTRN12613000722796, Ethics No. (HREC/13/LPOOL/60)
Physiotherapy
Trauma
