Ultrasonography in trauma: a nation-wide cross-sectional investigation

Abstract

Background: The Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark.

Methods: We conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation of existing guidelines, and the second phase was a series of structured interviews of orthopedic surgeons, anesthesiologists, and radiologists on call in all hospitals receiving traumatized patients in Denmark.

Results: Guidelines were obtained from all 22 hospitals receiving traumatized patients in Denmark. Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST indications varied between circulatory instability n = 8 (36.4%), team leader's discretion n = 6 (27.3%), abdominal trauma n = 3 (13.6%), and not specified n = 6 (27.3%). Telephone interviews revealed that exams were always n = 8 (36.4%) or often n = 4 (18.2%) registered in the patients' charts. The remaining n = 10 (45.5%) facilities either never registered n = 2 (9.1%), it was not possible to register n = 1 (4.5%), or unknown by the trauma leaders n = 7 (31.8%). Images were often stored in n = 1 (4.5%), never stored in n = 10 (45.5%), not possible to store in n = 2 (9.1%), and unknown in n = 9 (40.9%) facilities.

Conclusion: Ultrasonography was used in a non-uniform fashion by multiple specialties in Danish trauma facilities. Very few images from FAST examinations were stored and documentation was scanty. National guidelines on application and documentation of ultrasonography in trauma are called for.

Keywords: Emergency Medicine; FAST; Focused Assessment with Sonography in Trauma; Trauma; Ultrasonography.

Fig. 1

The FAST and eFAST exam. The blue probes illustrate the scanning positions of the FAST exam. The green probes illustrate the scanning positions of the extended FAST exam assessing for pneumothorax and hemothorax

Fig. 2

Specialties performing FAST. Specialties performing FAST examinations in trauma according to trauma care manuals and interviews with trauma leaders

Fig. 3

Indications (total n = 23) for performing FAST. Indications for performing FAST examination mentioned in the trauma manuals and number of hospitals

Fig. 4

Ultrasonography usage according to trauma leaders. Usage according to trauma leaders when asked how frequently ultrasonography is used in trauma care in their facility and number of hospitals

Fig. 5

Documentation. Documentation in patient charts and storage of ultrasonography images when ultrasonography is performed. Results from interviews with trauma leaders in all facilities. The graph shows the distribution of answers to two questions. Dark gray: “Are the results of the ultrasonography examination documented in the patient chart?” Light gray: “Are the images stored?”