Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Dec 1;5(12):e2245432.
doi: 10.1001/jamanetworkopen.2022.45432.

Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan

Fanny Planquart  1 , Emmanuel Marcaggi  2 , Raiko Blondonnet  3 , Olivier Clovet  4 , Xavier Bobbia  5 , Bastien Boussat  6 , Julien Pottecher  1   7 , Tobias Gauss  2 , Laurent Zieleskiewicz  8 , Pierre Bouzat  9
Affiliations
Multicenter Study

Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan

Fanny Planquart et al. JAMA Netw Open. .

Abstract

Importance: The extended Focused Assessment With Sonography for Trauma (E-FAST) has become a cornerstone of the diagnostic workup in patients with trauma. The added value of a diagnostic workup including an E-FAST to support decision-making remains unknown.

Objective: To determine how often an immediate course of action adopted in the resuscitation room based on a diagnostic workup that included an E-FAST and before whole-body computed tomography scanning (WBCT) in patients with blunt trauma was appropriate.

Design, setting, and participants: This cohort study was conducted at 6 French level I trauma centers between November 5, 2018, and November 5, 2019. Consecutive patients treated for blunt trauma were assessed at the participating centers. Data analysis took place in February 2022.

Exposures: Diagnostic workup associating E-FAST (including abdominal, thoracic, pubic, and transcranial Doppler ultrasonography scan), systematic clinical examination, and chest and pelvic radiographs.

Main outcomes and measures: The main outcome criterion was the appropriateness of the observed course of action (including abstention) in the resuscitation room according to evaluation by a masked expert panel.

Results: Of 515 patients screened, 510 patients (99.0%) were included. Among the 510 patients included, 394 were men (77.3%), the median (IQR) age was 46 years (29-61 years), and the median (IQR) Injury Severity Score (ISS) was 24 (17-34). Based on the initial diagnostic workup, no immediate therapeutic action was deemed necessary in 233 cases (45.7%). Conversely, the following immediate therapeutic actions were initiated before WBCT: 6 emergency laparotomies (1.2%), 2 pelvic angioembolisations (0.4%), 52 pelvic binders (10.2%), 41 chest drains (8.0%) and 16 chest decompressions (3.1%), 60 osmotherapies (11.8%), and 6 thoracotomies (1.2%). To improve cerebral blood flow based on transcranial doppler recordings, norepinephrine was initiated in 108 cases (21.2%). In summary, the expert panel considered the course of action appropriate in 493 of 510 cases (96.7%; 95% CI, 94.7%-98.0%). Among the 17 cases (3.3%) with inappropriate course of action, 13 (76%) corresponded to a deviation from existing guidelines and 4 (24%) resulted from an erroneous interpretation of the E-FAST.

Conclusions and relevance: This prospective, multicenter cohort study found that a diagnostic resuscitation room workup for patients with blunt trauma that included E-FAST with clinical assessment and targeted chest and pelvic radiographs was associated with the determination of an appropriate course of action prior to WBCT.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bobbia reported receiving grants from General Electric Healthcare outside the submitted work. Dr Pottecher reported receiving grants from Edwards Lifesciences and Masimo outside the submitted work. Dr Gauss reported receiving personal fees from Laboratoire du Biomédicament Français and nonfinancial support for a research partnership from Capgemini Invent outside the submitted work. Dr Zieleskiewicz reported receiving personal fees from General Electric Healthcare outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of the Study
Figure 2.
Figure 2.. Distribution of Appropriate and Inappropriate Course of Action per Type of Action
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Boulanger BR, McLellan BA, Brenneman FD, Ochoa J, Kirkpatrick AW. Prospective evidence of the superiority of a sonography-based algorithm in the assessment of blunt abdominal injury. J Trauma. 1999;47(4):632-637. doi:10.1097/00005373-199910000-00005 - DOI - PubMed
    1. Meyfroidt G, Bouzat P, Casaer MP, et al. . Management of moderate to severe traumatic brain injury: an update for the intensivist. Intensive Care Med. 2022;48(6):649-666. doi:10.1007/s00134-022-06702-4 - DOI - PubMed
    1. Depreitere B, Citerio G, Smith M, et al. . Cerebrovascular autoregulation monitoring in the management of adult severe traumatic brain injury: a delphi consensus of clinicians. Neurocrit Care. 2021;34(3):731-738. doi:10.1007/s12028-020-01185-x - DOI - PMC - PubMed
    1. Geeraerts T, Velly L, Abdennour L, et al. ; French Society of Anaesthesia; Intensive Care Medicine; in partnership with Association de neuro-anesthésie-réanimation de langue française (Anarlf); French Society of Emergency Medicine (Société Française de Médecine d’urgence (SFMU); Société française de neurochirurgie (SFN); Groupe francophone de réanimation et d’urgences pédiatriques (GFRUP); Association des anesthésistes-réanimateurs pédiatriques d’expression française (Adarpef) . Management of severe traumatic brain injury (first 24 hours). Anaesth Crit Care Pain Med. 2018;37(2):171-186. doi:10.1016/j.accpm.2017.12.001 - DOI - PubMed
    1. Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma. 2003;54(1):52-59. doi:10.1097/00005373-200301000-00007 - DOI - PubMed

Publication types