A possible role of e-FAST in the hemodynamically stable polytrauma patient: results of a single trauma center preliminary restrospective study

Abstract

Purpose: The purpose of this work is to evaluate whether EFAST can also play a role in the hemodynamically stable polytrauma patient, without delaying his arrival in the CT-scan room.

Methods: In a period of seven month, 748 polytrauma patients were retrospective valued; we analyzed the findings of the CT exams of 485 haemodynamically stable patients for whom the EFAST investigation was not requested, highlighting the possible presence of findings that, if reported during the EFAST, could have changed the patient management.

Results: 52 hemodynamically stable patients with CT examination findings potentially detectable by ultrasound examination directly in the shock room, which represent a percentage of about 11% of all the hemodynamically stable patients analyzed; about 54% of CT findings are represented by the presence of pneumothorax.

Conclusion: Looking to the results and the sensitivity of thoracic ultrasound in identifying even small flaps of pneumothorax, the evaluation by EFAST ultrasound examination could be extended at least to all those patients with chest trauma or who require endotracheal intubation. The risk of generating a hypertensive pneumothorax following positive pressure intubation is widely known, and certainly the presence of a pre-existing layer of pneumothorax, even if of modest entity, further increases this possibility.

Keywords: Ct scan; EFAST; Emergency; Pneumothorax; Polytrauma; Ultrasound.