Tertiary Survey Guidelines

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The Tertiary survey represents the final phase of the trauma evaluation.  Its purpose is to complete the physical exam in an awake patient and review final reads of studies and laboratory results.  The aim is to avoid missed injuries and the tertiary survey is part of the overall system of care.

48 hours is ideal, but this must timing must be balanced with the mental status of the patient.  An intubated patient may not be able to fully cooperate with the exam and the final tertiary survey may need to be delayed until post-extubation.  Astute judgment plays a role.

The Surgical chiefs will track and manage the completion of tertiary surveys on trauma patients.


Tertiary survey responsibilities based on patient location:

  • TBICU patients: 
    • The tertiary survey within 48 hours of arrival to TBICU or before transferring from ICU (if moving to floor/home prior to 48 hours post admit). 
  • Floor patients: 
    • The surgery primary team performs tertiary survey within 48 hours of admission or prior to discharge if leaving earlier than 48 hours. 
  • Surgical ICU, Emergency Dept. consults, existing consult (e.g trauma admit to Neuro ICU): 
    • ECR performs tertiary survey prior to discharge from ED or within 48 hours of admission to non-service ICU. 

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  1. Title: Tertiary Survey Guidelines
  2. Author:  Michigan Medicine
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  4. License: “CC BY-NC 4.0”

Tertiary Survey Guidelines,  Michigan Medicine, Dept of Surgery,  “CC BY-NC 4.0”

Last reviewed: 09 June 2021