Intra-oral trauma is commonly found in the multiply injured serviceman. Many evacuated patients remain intubated and unconscious producing difficulty in diagnosing intra-oral injury. Delays in recognition and treatment of such injuries can result in significant preventable long-term morbidity. It has therefore been recommended as a standard that all UK service personnel evacuated to the Royal Centre for Defence Medicine (RCDM) should have an intra-oral examination recorded in the hospital notes.
During a 2-month period (16 March–15 May 2010), the authors performed intra-oral examinations on all UK service personnel evacuated to RCDM. Any intra-oral pathology found was compared with that recorded in the hospital notes. 16 intra-oral injuries were found in 58 evacuated servicemen. 10/16 injuries were recorded in the hospital notes resulting in a compliance with the standard of 62%. Intra-oral injury was poorly recorded and often missed.
A modification to the trauma assessment sheet was made to account specifically for intra-oral trauma. Following this change re-audit was undertaken and during the period 1 January to 31 December 2011, the incidence of evacuated servicemen having intra-oral injuries documented increased to 81%. Knowledge of intra-oral injuries and their diagnosis was increased by education but some injuries were still missed. An educational programme has been established for clinicians working in the Intensive Care Unit, including a separate component on intra-oral injury diagnosis. The authors have demonstrated that by ensuring all battle-injured evacuated UK service personnel have a intra-oral examination recorded in the notes, long term morbidity due to missed injury can be reduced.
None (Ministry of Defence).