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Tertiary Survey Proforma for trauma – RHCG

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This guideline is intended to provide a framework for the ongoing clinical assessment of the child sustaining multiple injuries after significant trauma that has required admission to hospital.

Related documentation

Tertiary Survey proforma – ordered from Medical Illustration MI326638

Authorised personnel / specific staff competencies

The tertiary survey should be completed by a health care professional who is competent to assess a child for injuries. Examples of this are trauma/surgical ANP’s and any grade of medical practitioners who are involved in the patients inpatient care.

Equipment / materials

Tertiary Survey proforma – ordered from Medical Illustration MI326638


Aim of any repeat survey is to fully re-examine; formally review results of all investigations; consider cause of injury and any child protection concerns; focus on onward management plan; update the child and the family/carers.

The tertiary survey is ideally completed within first 48 hours of admission, or prior to discharge if less than 48 hours. If this is initially completed in PICU when the child remains sedated, this should then be repeated once transferred to the new receiving ward/team. The tertiary survey can be completed more than once per patient.

Audit & review process

This SOP will be reviewed every two years.

The Major Trauma Coordinators will audit for compliance with use of the Tertiary Survey Proforma.

Further information / exceptions

The tertiary survey is not necessarily required when end of life care is being discussed/considered.

Any planned or unplanned deviations from this SOP must be documented and reviewed by the appropriate personnel

For further information contact:
Major Trauma Coordinators
Ext: 84845/ 84930/ 84931

Appendix: example RHC Paediatric Trauma Survey form

NOTE: This image should not be printed. Forms must be ordered from Medical Illustration (MI326638)

Editorial Information

Last reviewed: 13 August 2021

Next review: 31 August 2023

Author(s): Mr Mark Lilley (Major trauma Co-ordinator, RHCG)

Co-Author(s): Co-authors / Stakeholders – Major Trauma team, RHCG – Dr Marie Spiers, Dr Christina Harry, Mrs Jenna Hills, Mrs Lynsay Stewart, Mr James Andrews, Ms Emer Campbell, Mr David Rowland

Approved By: Major Trauma Forum, RHCG