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Integrating eFAST in the initial management of stable trauma patients: the end of plain film radiography.

Hamada SR, Delhaye N, Kerever S, Harrois A, Duranteau J - Ann Intensive Care (2016)

Bottom Line: All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group.The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan.It allowed a sensible cost and radiation saving.

View Article: PubMed Central - PubMed

Affiliation: Anesthesiology and Critical Care Department, Service de Réanimation chirurgicale, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. sophiehamada@hotmail.com.

ABSTRACT

Background: The initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real "added value" of chest X-rays (CXRs) and pelvic X-rays (PXR), particularly in haemodynamically stable trauma patients. The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients.

Methods: This was a prospective, interventional, single-centre study including all primary blunt trauma patients admitted to the trauma bay with a suspicion of severe trauma. All patients underwent physical examination and eFAST (assessing abdomen, pelvis, pericardium and pleura) before a whole-body CT scan (WBCT). Patients fulfilling all stability criteria at any time in transit from the scene of the accident to the hospital were managed in the trauma bay without chest and PXR.

Results: Amongst 430 patients, 148 fulfilled the stability criteria (stability criteria group) of which 122 (82 %) had no X-rays in the trauma bay. No diagnostic failure with an immediate clinical impact was identified in the stability criteria group (SC group). All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group. The time spent in the trauma bay was significantly shorter for the SC group without X-rays compared to those who received any X-ray (25 [20; 35] vs. 38 [30; 60] min, respectively; p < 0.0001). An analysis of the cost and radiation exposure showed savings of 7000 Є and 100 mSv, respectively.

Conclusions: No unrecognized diagnostic with a clinical impact due to the lack of CXR and PXR during the initial management of stable trauma patients was observed. The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan. It allowed a sensible cost and radiation saving.

No MeSH data available.


Related in: MedlinePlus

Institutional protocol. *Criteria collected during prehospital and trauma bay period (before CT scan). SBP systolic blood pressure, HR heart rate, SpO2 peripheral oxygen saturation, GCS Glasgow Coma Scale, FAST focused assessment with sonography for trauma, CT scan computed tomography
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Fig1: Institutional protocol. *Criteria collected during prehospital and trauma bay period (before CT scan). SBP systolic blood pressure, HR heart rate, SpO2 peripheral oxygen saturation, GCS Glasgow Coma Scale, FAST focused assessment with sonography for trauma, CT scan computed tomography

Mentions: To select a population of haemodynamically stable trauma patients, we defined «stability criteria» as: minimum systolic arterial blood pressure (SAP) > 100 mmHg without vasopressor; maximum heart rate (HR) < 110 beats/min; minimum peripheral oxygen saturation (SpO2) > 94 %; minimum Glasgow Coma Score (GCS) > 13; no tracheal intubation; and a difference in capillary haemoglobin of <3 points between the first measurement performed by the prehospital team and the second measurement performed upon patient admission. These criteria had to be fulfilled at any time during transport from the scene of the trauma to hospital admission (Fig. 1). Patients were categorized into two groups: those who fulfilled all stability criteria were classed in the stability criteria group (SC group), whilst those who failed to meet one or more of the criteria were classed in the no stability criteria group (NSC group).Fig. 1


Integrating eFAST in the initial management of stable trauma patients: the end of plain film radiography.

Hamada SR, Delhaye N, Kerever S, Harrois A, Duranteau J - Ann Intensive Care (2016)

Institutional protocol. *Criteria collected during prehospital and trauma bay period (before CT scan). SBP systolic blood pressure, HR heart rate, SpO2 peripheral oxygen saturation, GCS Glasgow Coma Scale, FAST focused assessment with sonography for trauma, CT scan computed tomography
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940356&req=5

Fig1: Institutional protocol. *Criteria collected during prehospital and trauma bay period (before CT scan). SBP systolic blood pressure, HR heart rate, SpO2 peripheral oxygen saturation, GCS Glasgow Coma Scale, FAST focused assessment with sonography for trauma, CT scan computed tomography
Mentions: To select a population of haemodynamically stable trauma patients, we defined «stability criteria» as: minimum systolic arterial blood pressure (SAP) > 100 mmHg without vasopressor; maximum heart rate (HR) < 110 beats/min; minimum peripheral oxygen saturation (SpO2) > 94 %; minimum Glasgow Coma Score (GCS) > 13; no tracheal intubation; and a difference in capillary haemoglobin of <3 points between the first measurement performed by the prehospital team and the second measurement performed upon patient admission. These criteria had to be fulfilled at any time during transport from the scene of the trauma to hospital admission (Fig. 1). Patients were categorized into two groups: those who fulfilled all stability criteria were classed in the stability criteria group (SC group), whilst those who failed to meet one or more of the criteria were classed in the no stability criteria group (NSC group).Fig. 1

Bottom Line: All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group.The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan.It allowed a sensible cost and radiation saving.

View Article: PubMed Central - PubMed

Affiliation: Anesthesiology and Critical Care Department, Service de Réanimation chirurgicale, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. sophiehamada@hotmail.com.

ABSTRACT

Background: The initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real "added value" of chest X-rays (CXRs) and pelvic X-rays (PXR), particularly in haemodynamically stable trauma patients. The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients.

Methods: This was a prospective, interventional, single-centre study including all primary blunt trauma patients admitted to the trauma bay with a suspicion of severe trauma. All patients underwent physical examination and eFAST (assessing abdomen, pelvis, pericardium and pleura) before a whole-body CT scan (WBCT). Patients fulfilling all stability criteria at any time in transit from the scene of the accident to the hospital were managed in the trauma bay without chest and PXR.

Results: Amongst 430 patients, 148 fulfilled the stability criteria (stability criteria group) of which 122 (82 %) had no X-rays in the trauma bay. No diagnostic failure with an immediate clinical impact was identified in the stability criteria group (SC group). All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group. The time spent in the trauma bay was significantly shorter for the SC group without X-rays compared to those who received any X-ray (25 [20; 35] vs. 38 [30; 60] min, respectively; p < 0.0001). An analysis of the cost and radiation exposure showed savings of 7000 Є and 100 mSv, respectively.

Conclusions: No unrecognized diagnostic with a clinical impact due to the lack of CXR and PXR during the initial management of stable trauma patients was observed. The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan. It allowed a sensible cost and radiation saving.

No MeSH data available.


Related in: MedlinePlus