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. 2016 Dec;6(1):62.
doi: 10.1186/s13613-016-0166-0. Epub 2016 Jul 11.

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

Sophie Rym Hamada  1 , Nathalie Delhaye  2 , Sebastien Kerever  3   4   5 , Anatole Harrois  6 , Jacques Duranteau  6
Affiliations

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

Sophie Rym Hamada et al. Ann Intensive Care. 2016 Dec.

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.

Keywords: Diagnostic accuracy; Imaging; Resuscitation; Severe trauma; Stability; Ultrasound.

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Figures

Fig. 1
Fig. 1
Institutional protocol. *Criteria collected during prehospital and trauma bay period (before CT scan). SBP systolic blood pressure, HR heart rate, SpO 2 peripheral oxygen saturation, GCS Glasgow Coma Scale, FAST focused assessment with sonography for trauma, CT scan computed tomography
Fig. 2
Fig. 2
Flow chart of the study. X-R X-ray, CRX chest X-ray, PXR pelvic X-ray
See this image and copyright information in PMC

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References

    1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–757. doi: 10.1056/NEJMra0909487. - DOI - PubMed
    1. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–591. doi: 10.1007/s00134-012-2513-4. - DOI - PubMed
    1. Kirkpatrick AW, Ng AK, Dulchavsky SA, Lyburn I, Harris A, Torregianni W, et al. Sonographic diagnosis of a pneumothorax inapparent on plain radiography: confirmation by computed tomography. J Trauma Acute Care Surg. 2001;50:750–752. doi: 10.1097/00005373-200104000-00029. - DOI - PubMed
    1. Gentry Wilkerson R, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17:11–17. doi: 10.1111/j.1553-2712.2009.00628.x. - DOI - PubMed
    1. Abdulrahman Y, Musthafa S, Hakim SY, Nabir S, Qanbar A, Mahmood I, et al. Utility of extended FAST in blunt chest trauma: Is it the time to be used in the ATLS algorithm? World J Surg. 2015;39:172–178. doi: 10.1007/s00268-014-2781-y. - DOI - PubMed

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