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Sonographic scoring for operating room triage in trauma.

Manka M, Moscati R, Raghavendran K, Priya A - West J Emerg Med (2010)

Bottom Line: A previously-developed ultrasound scoring system was applied to the FAST findings.A simple scoring system (range 0-6) was developed that included both FAST findings and vital signs (heart rate and blood pressure).This derivation set must be validated prior to use in patient care.

View Article: PubMed Central - PubMed

Affiliation: Erie County Medical Center, Department of Emergency Medicine, Buffalo, NY.

ABSTRACT

Objective: The focused assessment with sonography for trauma (FAST) exam is a routine diagnostic adjunct in the initial assessment of blunt trauma victims but lacks the ability to reliably predict which patients require laparotomy. Physiologic data play a major role in decision making regarding the need for emergent laparotomy versus further diagnostic testing or observation. The need for laparotomy often influences the decision to transfer the patient to a trauma center. We set out to derive a simple scoring system using both ultrasound findings and immediately available physiologic data that would predict which patients require laparotomy.

Methods: We conducted a prospective observational study of victims of blunt trauma who presented to a Level 1 Trauma Center. We collected FAST findings, physiologic data, and lab values. A previously-developed ultrasound scoring system was applied to the FAST findings. Patients were followed to determine if they underwent laparotomy. We used logistic regression analysis to determine which variables correlated with laparotomy and developed a new scoring system.

Results: We enrolled a convenience sample of 1,393 patients. A simple scoring system (range 0-6) was developed that included both FAST findings and vital signs (heart rate and blood pressure). Patients with a score of 0 or 1 had a less than 1% chance of requiring laparotomy.

Conclusion: The combination of FAST findings with vital signs in our scoring system predicted which victims of blunt trauma did not undergo laparotomy. Applying this to trauma patients who present to non-trauma centers could help prevent unnecessary patient transfers. This derivation set must be validated prior to use in patient care.

No MeSH data available.


Related in: MedlinePlus

Subjects’ age distribution.
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f1-wjem-11-138: Subjects’ age distribution.

Mentions: We enrolled 1,393 patients, of whom 40 (2.9%) had urgent laparotomy. Subjects were 68% male. Age range was 14 to 94 years, with a median of 40 and an inter-quartile range of 25 to 55 (Figure 1). Of the 40 patients who had laparotomy, all were reported to have a therapeutic surgical intervention. Mean results for the reliably collected variables are demonstrated in Table 4. Time of injury, prehospital vital signs and fluid resuscitation volumes were not consistently available or accurately recorded (for example, pre-hospital respiratory rates showed little variability and were most often recorded as 20 breaths/minute). We analyzed the remaining variables for association with the need for laparotomy. Ultrasound score, initial ED SBP, and ED pulse were the only three variables associated with laparotomy.


Sonographic scoring for operating room triage in trauma.

Manka M, Moscati R, Raghavendran K, Priya A - West J Emerg Med (2010)

Subjects’ age distribution.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2908645&req=5

f1-wjem-11-138: Subjects’ age distribution.
Mentions: We enrolled 1,393 patients, of whom 40 (2.9%) had urgent laparotomy. Subjects were 68% male. Age range was 14 to 94 years, with a median of 40 and an inter-quartile range of 25 to 55 (Figure 1). Of the 40 patients who had laparotomy, all were reported to have a therapeutic surgical intervention. Mean results for the reliably collected variables are demonstrated in Table 4. Time of injury, prehospital vital signs and fluid resuscitation volumes were not consistently available or accurately recorded (for example, pre-hospital respiratory rates showed little variability and were most often recorded as 20 breaths/minute). We analyzed the remaining variables for association with the need for laparotomy. Ultrasound score, initial ED SBP, and ED pulse were the only three variables associated with laparotomy.

Bottom Line: A previously-developed ultrasound scoring system was applied to the FAST findings.A simple scoring system (range 0-6) was developed that included both FAST findings and vital signs (heart rate and blood pressure).This derivation set must be validated prior to use in patient care.

View Article: PubMed Central - PubMed

Affiliation: Erie County Medical Center, Department of Emergency Medicine, Buffalo, NY.

ABSTRACT

Objective: The focused assessment with sonography for trauma (FAST) exam is a routine diagnostic adjunct in the initial assessment of blunt trauma victims but lacks the ability to reliably predict which patients require laparotomy. Physiologic data play a major role in decision making regarding the need for emergent laparotomy versus further diagnostic testing or observation. The need for laparotomy often influences the decision to transfer the patient to a trauma center. We set out to derive a simple scoring system using both ultrasound findings and immediately available physiologic data that would predict which patients require laparotomy.

Methods: We conducted a prospective observational study of victims of blunt trauma who presented to a Level 1 Trauma Center. We collected FAST findings, physiologic data, and lab values. A previously-developed ultrasound scoring system was applied to the FAST findings. Patients were followed to determine if they underwent laparotomy. We used logistic regression analysis to determine which variables correlated with laparotomy and developed a new scoring system.

Results: We enrolled a convenience sample of 1,393 patients. A simple scoring system (range 0-6) was developed that included both FAST findings and vital signs (heart rate and blood pressure). Patients with a score of 0 or 1 had a less than 1% chance of requiring laparotomy.

Conclusion: The combination of FAST findings with vital signs in our scoring system predicted which victims of blunt trauma did not undergo laparotomy. Applying this to trauma patients who present to non-trauma centers could help prevent unnecessary patient transfers. This derivation set must be validated prior to use in patient care.

No MeSH data available.


Related in: MedlinePlus