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Schild-Suhren S, Yilmaz E, Biggemann L, Seif A, Torsello GF, Uhlig A, Ghadimi M, Bösch F. [Management of Injuries to the Parenchymal Abdominal Organs]. Zentralbl Chir 2024. [PMID: 38684170 DOI: 10.1055/a-2301-7951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
The most common organs affected by abdominal trauma are the spleen and the liver, often in combination. Pancreatic injuries are rare. In the case of blunt abdominal trauma, which is much more common, a clinical and laboratory examination as well as sonography should be performed. In the initial assessment, the circulatory situation must be screened. If there is haemodynamic instability and presentation of free fluid, an emergency laparotomy is indicated. If the situation is stable or stabilised and a pathological sonography is present, it is essential to perform triphasic contrast enhanced computed tomography, which is also mandatory in polytraumatised patients. If a renal injury is suspected, a late venous phase should be attached. In addition to the classification of the injury, attention should be paid to possible vascular injury or active bleeding. In this case, angiography with the possibility of intervention should be performed. Endoscopic treatment is possible for injuries of the pancreatic duct. If the imaging does not reveal any intervention target and a circulation is stable, a conservative approach is possible with continuous monitoring using clinical, laboratory and sonographic controls. Most injuries can be successfully treated by non-operative management (NOM).There are various surgical options for treating the injury, such as local and resecting procedures. There is also the option of "damage control surgery" with acute bleeding control and second look. Complex surgical procedures should be performed at centres. Postoperative complications arise out of elective surgery.In the less common case of penetrating abdominal trauma, the actual extent of the injury cannot be estimated from the visible wound. Here again, the circulatory situation determines the next steps. An emergency laparotomy should be carried out in case of instability. If the condition is stable, further diagnostics should be performed using contrast enhanced computed tomography. If penetration through the peritoneum cannot be clearly excluded, diagnostic laparoscopy should be performed.
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Affiliation(s)
- Stina Schild-Suhren
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Elif Yilmaz
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Lorenz Biggemann
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Ali Seif
- Institut für Diagnostische und Interventionelle Radiologie, Georg-August-Universität Göttingen, Gottingen, Deutschland
| | - Giovanni Federico Torsello
- Institut für Diagnostische und Interventionelle Radiologie, Georg-August-Universität Göttingen, Gottingen, Deutschland
| | - Annemarie Uhlig
- Klinik für Urologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Michael Ghadimi
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Florian Bösch
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
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Xue Z, Wen B. Bioanalytical evaluation of wound depth and musculoskeletal injuries: Synergizing focused assessment with sonography for trauma with computed tomography/magnetic resonance imaging in orthopaedic trauma care. Int Wound J 2024; 21:e14647. [PMID: 38272795 PMCID: PMC10805531 DOI: 10.1111/iwj.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Orthopaedic trauma care frequently necessitates prompt and precise assessment of musculoskeletal injuries and wound depth. The potential for improved diagnostic accuracy and patient outcomes exists with the integration of sophisticated imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) with focused assessment with sonography for trauma (FAST). The purpose of this research was to examine the benefits and drawbacks of this integrative method in the clinical environment. From June 2022 to September 2023, 250 patients who were admitted to Ningbo University Affiliated People's Hospital, participated in this cross-sectional observational study. Following the administration of FAST, CT and MRI were utilized to evaluate orthopaedic injuries and skin wounds in patients. Analyses of data centred on the precision of diagnoses, the influence of treatment decisions and patient outcomes. Aged and gendered differently, the study participants sustained the variety of injuries and superficial wounds that were predominantly the result of traffic accidents. The FAST assay exhibited sensitivity of 65%, specificity of 80% and 72% overall accuracy. MRI demonstrated the finest diagnostic performance (85% sensitivity, 95% specificity and 89% accuracy), whereas CT scans offered improved diagnostic efficacy (80% sensitivity, 90% specificity and 84% accuracy). Treatment decisions were substantially impacted by integration of these imaging modalities, resulting in modifications in 20%-35% of cases, depending on the specific modality employed. Specifically, MRI played a pivotal role in informing treatment approaches, influencing non-surgical as well as surgical procedures. This study substantiates the significant advantages of integrating FAST with CT and MRI in orthopaedic trauma care, particularly in the accurate assessment of wound depth. The synergistic use of these imaging techniques not only enhances diagnostic precision but also positively impacts treatment strategies and patient outcomes, emphasizing the need for a comprehensive diagnostic approach in trauma care settings.
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Affiliation(s)
- Zujun Xue
- OrthopedicsNingbo University Affiliated People's HospitalNingboChina
| | - Bi Wen
- Infection DepartmentNingbo University Affiliated People's HospitalNingboChina
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Comune R, Grassi F, Tamburrini S, Liguori C, Tamburro F, Masala S, Scaglione M. Traumatic segmental renal infarction due to renal apical artery thrombosis by minor blunt abdominal trauma: the role of CEUS. J Ultrasound 2023; 26:939-944. [PMID: 37610658 PMCID: PMC10632313 DOI: 10.1007/s40477-023-00817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Post-traumatic segmental renal infarction is an extremely rare event, especially in case of minor blunt abdominal trauma. While major trauma guidelines are well established, several problems account for the adequate management of minor trauma. Herein, we report a case of minor blunt abdominal trauma determining traumatic thrombosis of the apical renal artery and segmental renal infarction, firstly diagnosed by CEUS in emergency care setting.
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Affiliation(s)
- Rosita Comune
- Division of Radiology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80127, Naples, Italy.
| | - Francesca Grassi
- Division of Radiology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80127, Naples, Italy
| | | | - Carlo Liguori
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, 21, 07100, Sassari, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, 21, 07100, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
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Benhamed A, Fraticelli L, Claustre C, Gossiome A, Cesareo E, Heidet M, Emond M, Mercier E, Boucher V, David JS, El Khoury C, Tazarourte K. Risk factors and mortality associated with undertriage after major trauma in a physician-led prehospital system: a retrospective multicentre cohort study. Eur J Trauma Emerg Surg 2023; 49:1707-1715. [PMID: 36508023 DOI: 10.1007/s00068-022-02186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the incidence of undertriage in major trauma, its determinant, and association with mortality. METHODS A multicentre retrospective cohort study was conducted using data from a French regional trauma registry (2011-2017). All major trauma (Injury Severity Score ≥ 16) cases aged ≥ 18 years and managed by a physician-led mobile medical team were included. Those transported to a level-II/III trauma centre were considered as undertriaged. Multivariable logistic regression was used to identify factors associated with undertriage. RESULTS A total of 7110 trauma patients were screened; 2591 had an ISS ≥ 16 and 320 (12.4%) of these were undertriaged. Older patients had higher risk for undertriage (51-65 years: OR = 1.60, 95% CI [1.11; 2.26], p = 0.01). Conversely, injury mechanism (fall from height: 0.62 [0.45; 0.86], p = 0.01; gunshot/stab injuries: 0.45 [0.22; 0.90], p = 0.02), on-scene time (> 60 min: 0.62 [0.40; 0.95], p = 0.03), prehospital endotracheal intubation (0.53 [0.39; 0.71], p < 0.001), and prehospital focussed assessment with sonography [FAST] (0.15 [0.08; 0.29], p < 0.001) were associated with a lower risk for undertriage. After adjusting for severity, undertriage was not associated with a higher risk of mortality (1.22 [0.80; 1.89], p = 0.36). CONCLUSIONS In our physician-led prehospital EMS system, undertriage was higher than recommended. Advanced aged was identified as a risk factor highlighting the urgent need for tailored triage protocol in this population. Conversely, the potential benefit of prehospital FAST on triage performance should be furthered explored as it may reduce undertriage. Fall from height and penetrating trauma were associated with a lower risk for undertriage suggesting that healthcare providers should remain vigilant of the potential seriousness of trauma associated with low-energy mechanisms.
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Affiliation(s)
- Axel Benhamed
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France.
| | | | - Clément Claustre
- RESUVal and RESCUe Network, Lucien Hussel Hospital, Vienne, France
| | - Amaury Gossiome
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France
| | - Eric Cesareo
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France
| | - Matthieu Heidet
- SAMU 94 and Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP) University Hospital Henri Mondor, Créteil, France
- Université Paris-Est Créteil (UPEC), EA-3956 (CIR), Créteil, France
| | - Marcel Emond
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Eric Mercier
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Jean-Stéphane David
- Trauma Centre and Critical Care, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France
| | - Carlos El Khoury
- RESUVal and RESCUe Network, Lucien Hussel Hospital, Vienne, France
- Emergency Department, Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - Karim Tazarourte
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon, France
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Atalla M, Yacoub A, Al-Ali H, Lupia B, Ezzeddine L, Barzani S, Moussa M, Coey J, Alambrouk T, Hilal H. Investigating the Skill Development of Medical Students in Focused Assessment With Sonography for Trauma (FAST) Ultrasound: A Comparative Analysis Across Different Stages of Medical Training. Cureus 2023; 15:e44414. [PMID: 37664275 PMCID: PMC10469331 DOI: 10.7759/cureus.44414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Focused assessment with sonography for trauma (FAST) ultrasound (US) is a valuable medical examination used in trauma settings, particularly for rapid responses to events such as natural disasters. Although the efficacy and benefits of FAST in patient care have been extensively studied, there is limited research on training medical students in FAST. Previous studies have found that medical students can proficiently perform a FAST US after two days of training. However, these studies exclusively included first-year medical students without considering variations in their medical knowledge. Particularly, the advantage of medical students having US experience before undergoing FAST training has not been previously examined. OBJECTIVES Assess the performance and knowledge acquisition of medical students with and without prior US experience after completing a FAST training course. METHODS The study included a total of 71 students, consisting of 33 males and 38 females, who were between the ages of 18 and 31, with an average age of 24.6 and a standard deviation of 2.4. The inclusion criteria targeted first- and second-year medical school students who participated on a volunteer basis. Students were divided into two groups: group A, consisting of those without prior US experience, and group B, made up of those who had previous US experience. All students completed a pre-training survey to share their comfort and confidence in US use and knowledge. A baseline FAST exam was conducted to establish initial performance. A comprehensive three-hour training session was then provided. Post-training, students performed another FAST exam to assess improvement, followed by a post-training survey to evaluate comfort and confidence. RESULTS Medical students who had prior experience in the US (group B) performed significantly better (p<0.01) in both the pre- and post-training FAST exams when compared to students without previous US experience. Specifically, in locating the liver, right kidney, hepatorenal recess, and left kidney, as well as detecting fluid accumulation when in a supine position. Additionally, medical students with prior US experience (group B) exhibited higher baseline confidence (p<0.005-p<0.01) in their ability to perform a FAST exam, as indicated by the results of the pre-testing survey. CONCLUSION Previous experience with US significantly boosted confidence and knowledge gains following FAST training. This emphasizes the value of including US training in medical school programs after earlier exposure, offering evident benefits. The study reveals the unexplored benefit of having prior US experience for medical students undergoing FAST training, thus addressing a previously unexplored area in current research. The conclusions stress the necessity of integrating US training into medical school curricula after initial exposure. This understanding can direct medical educators in refining the education process, enabling students to be better equipped for real-world medical situations involving FAST.
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Affiliation(s)
- Michael Atalla
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Medical Imaging, University of Toronto, Toronto, CAN
| | - Andrew Yacoub
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Hasan Al-Ali
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Bianca Lupia
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Layal Ezzeddine
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Shaliz Barzani
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Michelle Moussa
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Faculty of Science, University of Waterloo, Waterloo, CAN
| | - James Coey
- Anatomy, St. George's University School of Medicine, Newcastle upon Tyne, GBR
| | - Tarek Alambrouk
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GRD
| | - Haider Hilal
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GBR
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Schild-Suhren S, Zygmunt AC, Biggemann L, Hosseini ASA, Ghadimi M, Bösch F. [Treatment recommendation and care in traumatic rupture of the spleen]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01873-2. [PMID: 37115223 DOI: 10.1007/s00104-023-01873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/29/2023]
Abstract
The spleen is the most frequently affected organ in blunt abdominal trauma. Initial diagnostics include the physical examination, laboratory blood controls and ultrasound. Furthermore, a triphasic dynamic contrast-enhanced computed tomography (CT) scan is indicated. Apart from the imaging-based classification of the injury with consideration of vascular alterations and active bleeding, the hemodynamic condition of the patient is a crucial factor. For patients who are hemodynamically stable or can be stabilized, a nonoperative management with a minimum of 24 h of continuous monitoring, regular blood controls of the hemoglobin level as well as ultrasound follow-up should be given precedence. In cases of active bleeding or pathological vascular alterations, a radiological intervention in the sense of an embolization should be initiated. A hemodynamically unstable patient must immediately undergo surgical treatment, during which a spleen-preserving approach via splenorrhaphy should principally be favored over splenectomy. This also applies to patients where the intervention has failed. To prevent severe infections after splenectomy it is advised to vaccinate against Pneumococcus, Haemophilus influenzae type B and Meningococcus as well as the annual seasonal influenza vaccination according to the Standing Committee on Vaccination (STIKO) recommendations.
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Affiliation(s)
- Stina Schild-Suhren
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Anne-Christine Zygmunt
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Lorenz Biggemann
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Ali Seif Amir Hosseini
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Michael Ghadimi
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Florian Bösch
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Gamberini L, Scquizzato T, Tartaglione M, Chiarini V, Mazzoli CA, Allegri D, Lupi C, Gordini G, Coniglio C, Brogi E. Diagnostic accuracy for hemoperitoneum, influence on prehospital times and time-to-definitive treatment of prehospital FAST: A systematic review and individual participant data meta-analysis. Injury 2023:S0020-1383(23)00280-2. [PMID: 36997363 DOI: 10.1016/j.injury.2023.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Focused assessment sonography for trauma (FAST) performed in the prehospital setting may improve trauma care by influencing treatment decisions and reducing time to definitive care, but its accuracy and benefits remain uncertain. This systematic review evaluated the diagnostic accuracy of prehospital FAST in detecting hemoperitoneum and its effects on prehospital time and time to definitive diagnosis or treatment. METHODS We systematically searched PubMed, Embase, and Cochrane library up to November 11th, 2022. Studies investigating prehospital FAST and reporting at least one outcome of interest for this review were considered eligible. The primary outcome was prehospital FAST diagnostic accuracy for hemoperitoneum. A random-effect meta-analysis, including individual patient data, was performed to calculate the pooled outcomes with 95% confidence intervals (CI). Quality of studies was assessed using the QUADAS-2 tool for diagnostic accuracy. RESULTS We included 21 studies enrolling 5790 patients. The pooled sensitivity and specificity of prehospital FAST for hemoperitoneum were 0.630 (0.454 - 0.777) and 0.970 (0.957-0.979), respectively. Prehospital FAST was performed in a median of 2.72 (2.12 - 3.31) minutes without increasing prehospital times (pooled median difference of 2.44 min [95% CI: -3.93 - 8.81]) compared to standard management. Prehospital FAST findings changed on-scene trauma care in 12-48% of cases, the choice of admitting hospital in 13-71%, the communication with the receiving hospital in 45-52%, and the transfer management in 52-86%. Patients with a positive prehospital FAST achieved definitive diagnosis or treatment more rapidly (severity-adjusted pooled time ratio = 0.63 [95% CI: 0.41 - 0.95]) compared with patients with a negative or not performed prehospital FAST. CONCLUSIONS Prehospital FAST had a low sensitivity but a very high specificity to identify hemoperitoneum and reduced time-to-diagnostics or interventions, without increasing prehospital times, in patients with a high probability of abdominal bleeding. Its effect on mortality is still under-investigated.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Valentina Chiarini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Cristian Lupi
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Etrusca Brogi
- Department of Anesthesia and Intensive care, University of Pisa, Pisa, Italy
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Sutarjono B, Kessel M, Alexander D, Grewal E. Is it time to re-think FAST? A systematic review and meta-analysis of Contrast-Enhanced Ultrasound (CEUS) and conventional ultrasound for initial assessment of abdominal trauma. BMC Emerg Med 2023; 23:8. [PMID: 36703099 PMCID: PMC9881326 DOI: 10.1186/s12873-023-00771-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The Focused Assessment with Sonography for Trauma (FAST) examination using conventional ultrasound has limited utility for detecting solid organ injury. Therefore, this systematic review and meta-analysis compares the performance of contrast-enhanced ultrasound (CEUS) to conventional ultrasound when used as the initial assessment for abdominal trauma prior to computed tomography (CT) imaging. METHODS A systematic literature search of major databases was conducted of human studies investigating the diagnostic accuracy of conventional ultrasound and CEUS occurring prior to CT imaging for abdominal trauma. The study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The quality of studies was evaluated using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Paired pooled sensitivity and specificity between conventional ultrasound and CEUS were compared using data extracted from the eligible studies. Diagnostic odds ratio, number needed to diagnose values, and likelihood ratios were also determined. RESULTS Ten studies were included. More than half of the included studies demonstrated low risk of bias. Using McNemar's test to assess for paired binary observations, we found that CEUS had statistically higher sensitivity (0.933 vs. 0.559; two-tailed, P < 0.001) and specificity (0.995 vs. 0.979; two-tailed, P < 0.001) than conventional ultrasound in the setting of abdominal trauma, respectively. When divided into particular findings of clinical interest, CEUS had statistically higher sensitivity than conventional ultrasound in screening for active bleeding and injuries to all abdominal solid organs. CEUS also had superior diagnostic odds ratios, number needed to diagnose values, and likelihood ratios than conventional ultrasound. CONCLUSION The diagnostic value of CEUS was higher than that of conventional ultrasound for differentiating traumatic abdominal injuries when used as the initial assessment in the emergency department.
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Affiliation(s)
- Bayu Sutarjono
- grid.287625.c0000 0004 0381 2434Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212 USA
| | - Matthew Kessel
- grid.287625.c0000 0004 0381 2434Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212 USA
| | - Dorian Alexander
- grid.287625.c0000 0004 0381 2434Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212 USA
| | - Ekjot Grewal
- grid.287625.c0000 0004 0381 2434Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212 USA
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9
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Planquart F, Marcaggi E, Blondonnet R, Clovet O, Bobbia X, Boussat B, Pottecher J, Gauss T, Zieleskiewicz L, Bouzat P. Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open 2022; 5:e2245432. [PMID: 36477480 PMCID: PMC9856525 DOI: 10.1001/jamanetworkopen.2022.45432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] 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.
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Affiliation(s)
- Fanny Planquart
- Service d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | | | - Raiko Blondonnet
- Pôle de Médecine Périopératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Clovet
- Département d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Xavier Bobbia
- Université de Montpellier, Département Urgences CHU Montpellier, Montpellier, France
| | - Bastien Boussat
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, laboratoire TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, Université Grenoble-Alpes, France
| | - Julien Pottecher
- Service d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, UR3072, Strasbourg, France
| | - Tobias Gauss
- Pôle d’Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Laurent Zieleskiewicz
- Service d’anesthésie réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, Centre de recherche en Cardiovasculaire et Nutrition, Aix-Marseille Université, France
| | - Pierre Bouzat
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
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10
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Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Blunt Abdominal Trauma. Emerg Med Int 2022; 2022:8290339. [PMID: 36247707 PMCID: PMC9568351 DOI: 10.1155/2022/8290339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to evaluate the accuracy and outcomes of focused assessment with sonography for trauma (FAST) and determine the factors associated with true-positive FAST results. Methods The FAST results from 2016 to 2020 were retrospectively reviewed. Cases involving penetrating injury, transfer from other hospitals, age ≤ 16 years, prehospital arrest, and no confirmatory test were excluded. Intra-abdominal fluid was confirmed using computed tomography or operative findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Demographic data, injury characteristics, and outcomes were compared between true-positive and false-negative results. Logistic regression was used to identify the factors associated with true-positive results. Results Of 2,758 patients, 163 and 2,595 patients showed positive and negative results, respectively. True positives were 135 and true negatives were 2325. The overall sensitivity, specificity, PPV, and NPV were 33.3%, 98.8%, 82.8%, and 89.6%, respectively. The sensitivity increased to 49.1% in patients with initial systolic blood pressure (SBP) ≤ 90 mmHg. The true-positive group showed a lower SBP and Glasgow Coma Scale score and a higher laparotomy rate than the false-negative group. However, mortality showed no significant difference. In logistic regression analysis, hollow viscus injury (1.820 [1.123–2.949], P=0.015) and the lowest SBP (0.988 [0.980–0.997], P=0.009) were associated with true-positive results compared to false-negative results. Conclusion The overall sensitivity of FAST was low; therefore, it should be performed in selected patients such as SBP ≤ 90 mmHg. Because of its low sensitivity and no influence on outcome, physicians should not rely solely on FAST.
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11
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Efficacy Evaluation of Ultrasound with Active Contour Model for Hemodialysis in Children with Renal Failure. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3665841. [PMID: 36035290 PMCID: PMC9410924 DOI: 10.1155/2022/3665841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022]
Abstract
This study was aimed to explore the efficacy of ultrasound with active contour model (ACM) for hemodialysis in children with renal failure. The pulse coupled neural network (PCNN) was used to extract the initial contour of the ultrasound images, and the cloud model-based ACM was used to accurately segment the images, whose effect was compared with the classic Snake model. 84 children with chronic renal failure who received hemodialysis treatment in hospital were selected as research objects. There were 42 cases in the control group who were diagnosed by conventional ultrasound and 42 cases in the observation group who were diagnosed by ultrasound with the algorithm. Then, 42 children who underwent healthy physical examination (health group) were selected for comparison of related analysis indicators. The error rates of different algorithms were compared to analyze the levels of inflammatory factors in different groups of patients after hemodialysis. The results showed that the error rate of classical Snake model was 18.87% and that of ACM algorithm model was 11.01%, and the error rate of ACM algorithm model was significantly lower (
). After hemodialysis, the level of tumor necrosis factor (TNF)-α was 38.76 pg/mL in the observation group and 40.05 pg/mL in the control group, which was notably decreased in both groups, especially in the observation group (
). After hemodialysis, transforming growth factor (TGF)-β1 was 7.76 ng/mL in the observation group and 7.60 ng/mL in the control group, which was significantly reduced in both groups. After treatment, UA and Scr in both groups were significantly reduced, and the reduction was more significant in the observation group (
). HGB and RBC were significantly increased in both groups, and the increase was more significant in the observation group (
). In summary, ACM algorithm had a good segmentation effect on the ultrasonic images of children with renal failure. This study provided guidance for clinicians to choose the algorithm for the application of ultrasonic imaging diagnosis.
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12
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Imaging Features of Main Posthepatectomy Complications: A Radiologist’s Challenge. Diagnostics (Basel) 2022; 12:diagnostics12061323. [PMID: 35741133 PMCID: PMC9221607 DOI: 10.3390/diagnostics12061323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022] Open
Abstract
In the recent years, the number of liver resections has seen an impressive growth. Usually, hepatic resections remain the treatment of various liver diseases, such as malignant tumors, benign tumors, hydatid disease, and abscesses. Despite technical advancements and tremendous experience in the field of liver resection of specialized centers, there are moderately high rates of postoperative morbidity and mortality, especially in high-risk and older patient populations. Although ultrasonography is usually the first-line imaging examination for postoperative complications, Computed Tomography (CT) is the imaging tool of choice in emergency settings due to its capability to assess the whole body in a few seconds and detect all possible complications. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for delineating early postoperative bile duct injuries and ischemic cholangitis that may arise in the late postoperative phase. Moreover, both MDCT and MRCP can precisely detect tumor recurrence. Consequently, radiologists should have knowledge of these surgical procedures for better comprehension of postoperative changes and recognition of the radiological features of various postoperative complications.
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13
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Gamberini L, Tartaglione M, Giugni A, Alban L, Allegri D, Coniglio C, Lupi C, Chiarini V, Mazzoli CA, Heusch-Lazzeri E, Tugnoli G, Gordini G. The role of prehospital ultrasound in reducing time to definitive care in abdominal trauma patients with moderate to severe liver and spleen injuries. Injury 2022; 53:1587-1595. [PMID: 34920877 DOI: 10.1016/j.injury.2021.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/04/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The role of prehospital focused assessment sonography for trauma (FAST) is still under debate and no definitive recommendations are available in actual guidelines, moreover, the availability of ultrasound machines in emergency medical services (EMS) is still inhomogeneous. On the other hand, time to definitive care is strictly related to survival in bleeding trauma patients. This study aimed at investigating if a positive prehospital FAST in abdominal trauma patients could have a role in reducing door-to-CT scan or door-to-operating room (OR) time. METHODS This retrospective observational study included all the patients affected by an abdominal trauma with an abdominal abbreviated injury score ≥ 2 and a spleen or liver injury admitted to Maggiore Hospital Carlo Alberto Pizzardi, a level 1 trauma centre between 2014 and 2019. Prehospital and emergency department (ED) clinical and laboratory variables were collected, as well as in-hospital times during the diagnostic and therapeutic pathways of these patients. RESULTS 199 patients were included in the final analysis. Of these, 44 had a prehospital FAST performed and in 27 of them, peritoneal free fluid was detected in the prehospital setting, while 128 out of 199 patients had a positive ED-FAST. Sensitivity was 62.9% (95% CI: 42.4%-80.6%) and specificity 100% (95% CI: 80.5% - 100%). Patients with a positive prehospital FAST reported a significantly lower door-to-CT or door-to-OR median time (46 vs 69 min, p < 0.001). Prehospital hypotension and Glasgow coma scale, first arterial blood lactate, ISS, age, positive prehospital and ED FAST were inserted in a stepwise selection for a multivariable Cox proportional regression hazards model. Only ISS and prehospital FAST resulted significantly associated with a reduction in the door-to-CT scan or door-to-operating theatre time in the multivariable model. CONCLUSION Prehospital FAST information of intraperitoneal free fluid could significantly hasten door-to-CT scan or door-to-operating theatre time in abdominal trauma patients if established hospital response protocols are available. LEVEL OF EVIDENCE III, (Therapeutic / Care Management).
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy.
| | - Aimone Giugni
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Laura Alban
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Cristian Lupi
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Valentina Chiarini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Carlo Alberto Mazzoli
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Elena Heusch-Lazzeri
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Nigrisoli 2, Bologna 40133, Italy
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14
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Mayo PH, Chew M, Douflé G, Mekontso-Dessap A, Narasimhan M, Vieillard-Baron A. Machines that save lives in the intensive care unit: the ultrasonography machine. Intensive Care Med 2022; 48:1429-1438. [PMID: 35941260 PMCID: PMC9360728 DOI: 10.1007/s00134-022-06804-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
This article highlights the ultrasonography machine as a machine that saves lives in the intensive care unit. We review its utility in the limited resource intensive care unit and some elements of machine design that are relevant to both the constrained operating environment and the well-resourced intensive care unit. As the ultrasonography machine can only save lives, if is operated by a competent intensivist; we discuss the challenges of training the frontline clinician to become competent in critical care ultrasonography followed by a review of research that supports its use.
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Affiliation(s)
- Paul H. Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- AP-HP Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010 Créteil, France ,Univ Paris Est Créteil, CARMAS, 94010 Créteil, France ,Univ Paris Est Créteil, INSERM, IMRB, 94010 Créteil, France
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Antoine Vieillard-Baron
- Intensive Care Medicine, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France
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15
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Hilbert-Carius P, Struck MF, Rudolph M, Knapp J, Rognås L, Adler J, Slagt C, Jacobsen L, Pich H, Christian MD, Dandrifosse D, Abu-Zidan FM. Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey. Scand J Trauma Resusc Emerg Med 2021; 29:124. [PMID: 34446076 PMCID: PMC8390051 DOI: 10.1186/s13049-021-00933-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey. Method A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminding notes. Results During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n = 66) completed the survey. POCUS was available in 75% (56% always when needed and 19% occasionally) of the responding HEMS organizations. 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n = 46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common protocol used. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations. Conclusions The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are not available in about two thirds of the European HEMS organizations. Due to several limitations of this survey further studies are needed to evaluate POCUS in HEMS. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00933-y.
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Affiliation(s)
- Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, BG Klinikum Bergmannstrost Halle gGmbH, and HEMS, Christoph 84" and "Christoph 85", DRF-Luftrettung, Halle (Saale), Germany
| | - Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, and HEMS "Christoph 33"and "Christoph 71, Senftenberg, Germany
| | - Marcus Rudolph
- DRF Stiftung Luftrettung Gemeinnützige AG, Filderstadt, Germany
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Jörn Adler
- Luxembourg Air Rescue A.S.B.L, Sandweiler, Luxembourg
| | - Cor Slagt
- Department of Anesthesiology, Pain and Palliative Medicine and Helicopter Emergency Medical Service, Lifeliner 3" and "Lifeliner 5", Radboudumc, Nijmegen, The Netherlands
| | - Lars Jacobsen
- Sørlandet Hospital, Air Ambulance dpt, Arendal, Norway.,The Norwegian Air Ambulance Foundation, Arendal, Norway
| | - Henryk Pich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany.,HEMS "Christoph 33"and "Christoph 71", Senftenberg, Germany
| | | | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
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16
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Naganuma H, Ishida H. One-day seminar for residents for implementing abdominal pocket-sized ultrasound. World J Methodol 2021; 11:208-221. [PMID: 34322370 PMCID: PMC8299907 DOI: 10.5662/wjm.v11.i4.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/10/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Despite its proven high utility, integration of pocked-sized portable ultrasound (US) into internal medicine residency training remains inconsistent. For 10 years, we have held a 1-d seminar biannually, consisting of lecture (half-day) and hands-on training (half-day) on pocket-sized US of the abdomen and lungs. The lecture consists of training on US physics and clinical applications of pocket-sized US, followed by a lecture covering the basic anatomy of the abdomen and lungs and introducing the systemic scanning method. Given the simple structure of pocket-sized US devices, understanding the basic physics is sufficient yet necessary to operate the pocket-sized US device. It is important to understand the selection of probes, adjustment of B mode gain, adjustment of color gain, and acoustic impedance. Basic comprehension may have a significant positive impact on the overall utilization of pocket-sized US devices. The easiest and most reliable way to observe the whole abdomen and lungs is a combination of transverse, sagittal, and oblique scanning, pursuing the main vascular system from the center to the periphery of the organ in the abdomen and systemic scanning of the pleura. There is usually a marked change in knowledge and attitudes among the program participants, although skill gaps remain among them. We discuss the limitations and problems to this education system as well.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote 0138602, Akita, Japan
| | - Hideaki Ishida
- Department of Gastroenterology, Akita Red Cross Hospital, Akita-City 010-1495, Japan
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17
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Sumann G, Moens D, Brink B, Brodmann Maeder M, Greene M, Jacob M, Koirala P, Zafren K, Ayala M, Musi M, Oshiro K, Sheets A, Strapazzon G, Macias D, Paal P. Multiple trauma management in mountain environments - a scoping review : Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel. Scand J Trauma Resusc Emerg Med 2020; 28:117. [PMID: 33317595 PMCID: PMC7737289 DOI: 10.1186/s13049-020-00790-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.
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Affiliation(s)
- G Sumann
- Austrian Society of Mountain and High Altitude Medicine, Emergency physician, Austrian Mountain and Helicopter Rescue, Altach, Austria
| | - D Moens
- Emergency Department Liège University Hospital, CMH HEMS Lead physician and medical director, Senior Lecturer at the University of Liège, Liège, Belgium
| | - B Brink
- Mountain Emergency Paramedic, AHEMS, Canadian Society of Mountain Medicine, Whistler Blackcomb Ski Patrol, Whistler, Canada
| | - M Brodmann Maeder
- Department of Emergency Medicine, University Hospital and University of Bern, Switzerland and Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - M Greene
- Medical Officer Mountain Rescue England and Wales, Wales, UK
| | - M Jacob
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospitallers Brothers Saint-Elisabeth-Hospital Straubing, Bavarian Mountain Rescue Service, Straubing, Germany
| | - P Koirala
- Adjunct Assistant Professor, Emergency Medicine, University of Maryland School of Medicine, Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - K Zafren
- ICAR MedCom, Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA.,Alaska Native Medical Center, Anchorage, AK, USA
| | - M Ayala
- University Hospital Germans Trias i Pujol, Badalona, Spain
| | - M Musi
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - K Oshiro
- Department of Cardiovascular Medicine and Director of Mountain Medicine, Research, and Survey Division, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - A Sheets
- Emergency Department, Boulder Community Health, Boulder, CO, USA
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,The Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy
| | - D Macias
- Department of Emergency Medicine, International Mountain Medicine Center, University of New Mexico, Albuquerque, NM, USA
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria.
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18
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Wirth S, Hebebrand J, Basilico R, Berger FH, Blanco A, Calli C, Dumba M, Linsenmaier U, Mück F, Nieboer KH, Scaglione M, Weber MA, Dick E. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging 2020; 11:135. [PMID: 33301105 PMCID: PMC7726597 DOI: 10.1186/s13244-020-00947-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. RESULTS Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org ) and a short version also covering all recommendations (this article). CONCLUSIONS Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.
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Affiliation(s)
- Stefan Wirth
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria.
- Department of Radiology, LMU University Hospital, Munich, Germany.
- Department of Radiology and Nuclear Medicine, Schwarzwald-Baar-Hospital, Villingen-Schwenningen, Germany.
| | - Julian Hebebrand
- Department of Radiology, LMU University Hospital, Munich, Germany
| | - Raffaella Basilico
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Neurosciences, Imaging and Clinical Science, University of Chieti, Chieti, Italy
| | - Ferco H Berger
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ana Blanco
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Hospital JM Morales Meseguer, Murcia, Spain
| | - Cem Calli
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, Ege University Medical Faculty, Izmir, Turkey
| | - Maureen Dumba
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
| | - Ulrich Linsenmaier
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Fabian Mück
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Konraad H Nieboer
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Ziekenhuis, Vrije University (VUB), Brussels, Belgium
| | - Mariano Scaglione
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- James Cook University Hospital, Teesside University, Middlesbrough, UK
- Department of Imaging, Pineta Grande Hospital, Castel Volturno, Italy
| | - Marc-André Weber
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Elizabeth Dick
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
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Stengel D, Mutze S, Güthoff C, Weigeldt M, von Kottwitz K, Runge D, Razny F, Lücke A, Müller D, Ekkernkamp A, Kahl T. Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma. JAMA Surg 2020; 155:224-232. [PMID: 31940019 PMCID: PMC6990738 DOI: 10.1001/jamasurg.2019.5468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Question Is low-dose whole-body computed tomography with statistical image reconstruction associated with similar rates of missed injuries and accuracy but reduced radiation exposure compared with standard-dose whole-body computed tomography in the primary diagnostic workup of blunt multiple trauma? Findings In this quasi-experimental cohort study of 971 patients with suspected blunt multiple trauma, participants in the standard-dose and low-dose whole-body computed tomography groups had the same risk of missed injury diagnoses. Low-dose scanning markedly reduced exposure to radiation, improved the contrast-to-noise ratio, and showed similar diagnostic accuracy among the investigated anatomical areas and organs when compared with standard-dose scanning. Meaning These findings suggest that low-dose whole-body computed tomography may safely replace standard-dose scanning in the primary diagnostic workup of blunt multiple trauma. Importance Initial whole-body computed tomography (WBCT) for screening patients with suspected blunt multiple trauma remains controversial and a source of excess radiation exposure. Objective To determine whether low-dose WBCT scanning using an iterative reconstruction algorithm does not increase the rate of missed injury diagnoses at the point of care compared with standard-dose WBCT with the benefit of less radiation exposure. Design, Setting, and Participants This quasi-experimental, prospective time-series cohort study recruited 1074 consecutive patients admitted for suspected blunt multiple trauma to an academic metropolitan trauma center in Germany from September 3, 2014, through July 26, 2015, for the standard-dose protocol, and from August 7, 2015, through August 20, 2016, for the low-dose protocol. Five hundred sixty-five patients with suspected blunt multiple trauma prospectively received standard-dose WBCT, followed by 509 patients who underwent low-dose WBCT. Confounding was controlled by segmented regression analysis and a secondary multivariate logistic regression model. Data were analyzed from January 16, 2017, through October 14, 2019. Interventions Standard- or low-dose WBCT. Main Outcomes and Measures The primary outcome was the incidence of missed injury diagnoses at the point of care, using a synopsis of clinical, surgical, and radiological findings as an independent reference test. The secondary outcome was radiation exposure with either imaging strategy. Results Of 1074 eligible patients, 971 (mean [SD] age, 52.7 [19.5] years; 649 men [66.8%]) completed the study. A total of 114 patients (11.7%) had multiple trauma, as defined by an Injury Severity Score of 16 or greater. The proportion of patients with any missed injury diagnosis at the point of care was 109 of 468 (23.3%) in the standard-dose and 107 of 503 (21.3%) in the low-dose WBCT groups (risk difference, −2.0% [95% CI, −7.3% to 3.2%]; unadjusted odds ratio, 0.89 [95% CI, 0.66-1.20]; P = .45). Adjustments for autocorrelation and multiple confounding variables did not alter the results. Radiation exposure, measured by the volume computed tomography dose index, was lowered from a median of 11.7 (interquartile range, 11.7-17.6) mGy in the standard-dose WBCT group to 5.9 (interquartile range, 5.9-8.8) mGy in the low-dose WBCT group (P < .001). Conclusions and Relevance Low-dose WBCT using iterative image reconstruction does not appear to increase the risk of missed injury diagnoses at the point of care compared with standard-dose protocols while almost halving the exposure to diagnostic radiation.
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Affiliation(s)
- Dirk Stengel
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
| | - Sven Mutze
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,Institute for Diagnostic Radiology and Neuroradiology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claas Güthoff
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Moritz Weigeldt
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Konrad von Kottwitz
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Domenique Runge
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Filip Razny
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Anna Lücke
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Dirk Müller
- Consultant in radiation physics, Hamburg, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany.,Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Kahl
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
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20
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He NX, Yu JH, Zhao WY, Gu CF, Yin YF, Pan X, Zhong H. Clinical value of bedside abdominal sonography performed by certified sonographer in emergency evaluation of blunt abdominal trauma. Chin J Traumatol 2020; 23:280-283. [PMID: 32762981 PMCID: PMC7567895 DOI: 10.1016/j.cjtee.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma. METHODS The study was carried out from 2017 to 2019. Findings in operations or on computed tomography (CT) were used as references to evaluate the accuracy of bedside abdominal ultrasonography. The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application. RESULTS Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma, of which 71 critical patients received surgery. The overall diagnostic accordance rate was 88.68%. The diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation, retroperitoneal hematoma and multiple abdominal organ injury were 100%, 94.73%, 94.12%, 20.00%, 100% and 81.48%, respectively. Among the 71 critical patients, the diagnostic accordance rate was 94.37%, in which the diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation and multiple abdominal organ injury were 100%, 100%, 100%, 20.00% and 100%. The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan (4.45 ± 1.63 vs. 2.38 ± 1.19) min; however, the mean waiting time before examination (7.37 ± 2.01 vs. 16.42 ± 6.37) min, the time to make a diagnostic report (6.42 ± 3.35 vs. 36.26 ± 13.33) min, and the overall time (17.24 ± 2.33 vs. 55.06 ± 6.96) min were shorter for bedside abdominal ultrasonography than for CT scan. CONCLUSION Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma. Especially for patients with free peritoneal effusion and critical patients, bedside ultrasonography has been proved obvious advantageous. However, for negative bedside ultrasonography patients with blunt abdominal trauma, we recommend further abdominal CT scan or serial ultrasonography scans subsequently.
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Affiliation(s)
- Nie-Xia He
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jin-Hui Yu
- Department of Neurosurgery, Chongqing Yubei District People's Hospital, Chongqing, China
| | - Wan-Yi Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chun-Fang Gu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ya-Fei Yin
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xu Pan
- Department of Ultrasound, Chungking General Hospital, Chongqing, China
| | - Hua Zhong
- College of Biomedical Engineering and Imaging Medicine of Army Medical University, Chongqing, China,Corresponding author.
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21
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Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation. Eur J Trauma Emerg Surg 2020; 48:921-931. [PMID: 32997166 PMCID: PMC9001527 DOI: 10.1007/s00068-020-01502-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/15/2020] [Indexed: 12/03/2022]
Abstract
Purpose The indication of whole body computed tomography (WBCT) in the emergency treatment of trauma is still under debate. We were interested in the detailed information gain obtained from WBCT following standardized conventional imaging (CI). Methods Prospective study including all emergency trauma centre patients examined by CI (focused assessment of sonography in trauma, chest and pelvic X-ray) followed by WBCT from 2011 to 2017. Radiology reports were compared per patient for defined body regions for number and severity of injuries (Abbreviated Injury Scale, AIS; Injury Severity Score, ISS), incidental findings and treatment consequences (Wilcoxon signed rank test, Spearman rho, Chi-square). Results 1271 trauma patients (ISS 11.3) were included in this study. WBCT detected more injury findings than CI in the equivalent body regions (1.8 vs. 0.6; p < 0.001). In 44.4% of cases at least one finding was missed by CI alone. Compared to WBCT, injury severity of specified body regions was underestimated by CI on average by an AIS of 1.9 (p < 0.001). In 22.0% of cases injury severity increased by an AIS ≥ 2 following WBCT. In 16.8% of patients additional injury findings resulted in a change of treatment (number needed to profit, NNP = 6 patients): NNP decreased from 25 for patients with an ISS < 7 up to nearly 2 for patients with an ISS > 25 at final evaluation, thereby demonstrating a significant improvement in the NNP with increasing ISS (rho = 0.33, p < 0.001). Moreover, WBCT in 88.4% of patients identified ≥ 1 incidental finding (mean 3.4) vs. 28.9% by CI only (p < 0.001). Overall, WBCT had treatment consequences in 31.9% of cases (NNP = 3.1). Conclusions The application of WBCT in addition to CI in the emergency treatment of trauma had therapy consequences for almost every third patient. On the other hand, WBCT appeared not to be indicated (ISS < 8) in at least 2/5 of patients. Electronic supplementary material The online version of this article (10.1007/s00068-020-01502-1) contains supplementary material, which is available to authorized users.
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22
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Qi X, Tian J, Sun R, Zhang H, Han J, Jin H, Lu H. Focused Assessment with Sonography in Trauma for Assessment of Injury in Military Settings: A Meta-analysis. Balkan Med J 2019; 37:3-8. [PMID: 31594286 PMCID: PMC6934008 DOI: 10.4274/balkanmedj.galenos.2019.2019.8.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Non-invasive, rapid, and precise assessment of injury in the military settings is extremely important, yet difficult. Focused assessment with sonography in trauma (FAST) is being increasingly employed for assessing the location and severity of injury and guiding further treatment strategy. However, the evidence regarding the utility of FAST in the military settings is scattered. AIMS To evaluate the diagnostic performance of FAST in the assessment of injury in the military settings. STUDY DESIGN Meta-analysis. METHODS We identified all relevant papers via the PubMed, EMBASE, and Cochrane Library databases. We evaluated the quality of included studies by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We pooled the area under the curve (AUC), sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio as the effect sizes, followed by evaluating the heterogeneity among the studies by p value and I2. RESULTS Among the 39 papers, a total of six papers were included. The sample size ranged from 15 to 396. The AUC of FAST for assessing the injury was 0.85. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.66, 0.98, 33.1, 0.34, and 97, respectively. The heterogeneity among the studies was statistically significant (p=0.006, I2=78%). CONCLUSION FAST is potentially valuable for assessing injury in the military settings. Due to its high specificity, FAST may be appropriate to rule in significant injury. However, because of its poor sensitivity, the ability of FAST to rule out injury cannot be relied upon.
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Affiliation(s)
- Xingshun Qi
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
- Co-first authors
- Co-corresponding authors
- * Address for Correspondence: Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China E-mail:,
| | - Jing Tian
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
- Co-first authors
| | - Rui Sun
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - He Zhang
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - Jinsong Han
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - Hai Jin
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - Hui Lu
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
- Co-corresponding authors
- * Address for Correspondence: Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China E-mail:,
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23
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Engles S, Saini NS, Rathore S. Emergency Focused Assessment with Sonography in Blunt Trauma Abdomen. Int J Appl Basic Med Res 2019; 9:193-196. [PMID: 31681541 PMCID: PMC6822327 DOI: 10.4103/ijabmr.ijabmr_273_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/08/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Focused assessment with sonography in trauma (FAST) being a rapid noninvasive examination is used primarily to evaluate for the evidence of traumatic free fluid suggestive of injury in the peritoneal, pericardial, and pleural cavities. It is widely recognized as a mainstream emergency skill in the management of trauma. Aim: The aim of the study is to evaluate the accuracy of FAST in patients presenting with blunt abdominal trauma. Methods: Data were collected prospectively from FAST scans conducted in blunt trauma abdomen (BTA) patients. Positive and negative FAST scans were confirmed either with contrast-enhanced computed tomography (CECT) abdomen or with exploratory laparotomy, thus dividing it further into four groups, i.e., true-positive, false-positive, true-negative, and false-negative scans. After collecting the data, accuracy of FAST was calculated. Results: In this study, a total of 104 patients were included. The mean age was 38.17 years. Most common cause of BTA was road traffic accident. The overall sensitivity, specificity, and accuracy of FAST were 69.8%, 92.1%, and 80.8%, respectively. Conclusion: This study showed that FAST is of paramount importance in patients who are hemodynamically unstable as it has a high positive predictive value. However, a FAST-negative result should always be confirmed by other modalities.
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Affiliation(s)
- Shradha Engles
- Department of Vascular Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Navdeep Singh Saini
- Departments of General Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Shubra Rathore
- Departments of Radiodiagnosis, Christian Medical College, Ludhiana, Punjab, India
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24
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Eicken JJ, Morrow D. Limb threatening thigh hematoma diagnosis accelerated by emergency physician bedside ultrasound. SAGE Open Med Case Rep 2019; 7:2050313X19848589. [PMID: 31105957 PMCID: PMC6503592 DOI: 10.1177/2050313x19848589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/09/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction: Compartment syndrome is a serious condition that requires prompt diagnosis,
specialty consultation, and definitive management to prevent significant
morbidity. Traditionally, compartment syndrome is identified by physical
exam findings including the presence of pain, pallor, paresthesia,
pulselessness, and paralysis involving the affected limb. Identifying the
presence of compartment syndrome prior to the onset of signs that portend a
poor outcome (i.e. pallor, pulselessness, and paralysis) can be challenging
since many other less serious traumatic conditions can lead to paresthesia
and pain in a limb. Bedside ultrasound is increasingly being utilized by
emergency providers to expedite identification of various emergent diagnoses
and guide care for patients who present to emergency departments. Bedside
ultrasound allows emergency providers to visualize pathologic processes
occurring that may be difficult to identify through traditional physical
exam findings. This case report highlights the use of bedside ultrasound to
promptly identify the presence of a traumatic thigh hematoma, which led to
expedited advanced imaging and specialty consultation for compartment
syndrome prior to the onset of physical exam findings
consistent with compartment syndrome. Conclusion: The identification of compartment syndrome in the early stages is challenging
given the overlap of signs and symptoms with other less emergent conditions.
Early diagnosis of compartment syndrome is important to decrease morbidity,
which can result from a delayed diagnosis of compartment syndrome. To our
knowledge, this is the first case report to describe the use of bedside
ultrasound to aid in the diagnosis of compartment syndrome and accelerate
the care for a patient who presented with a traumatic thigh hematoma, which
rapidly progressed to compartment syndrome and required emergent operative
intervention.
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Affiliation(s)
- John J Eicken
- Division of Emergency Ultrasound, Department of Emergency Medicine, Greenville Memorial Hospital, Prisma Health - Upstate, Greenville, SC, USA.,School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Dustin Morrow
- Division of Emergency Ultrasound, Department of Emergency Medicine, Greenville Memorial Hospital, Prisma Health - Upstate, Greenville, SC, USA.,School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
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Shi D, Liu J, Xu J, Zhu H, Yu X. Evaluation of a new goal-directed training curriculum for point-of-care ultrasound in the emergency department: impact on physician self-confidence and ultrasound skills. Eur J Trauma Emerg Surg 2019; 47:435-444. [PMID: 30963185 PMCID: PMC8016812 DOI: 10.1007/s00068-019-01126-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/29/2019] [Indexed: 02/05/2023]
Abstract
Purpose Developing countries need effective and efficient training curriculum for the point-of-care ultrasound (POCUS) in the emergency department (ED). We have developed a new goal-directed training curriculum focusing on critical POCUS procedures used in ED. Methods To evaluate the impact of the new POCUS curriculum on ED physicians’ performance/self-confidence, we carried out a quasi-experimental trial at ED training center of Peking Union Medical College Hospital, in which we trained two groups of physicians using either traditional curriculum or the new goal-directed curriculum. We measured the confidence in performing Focused Assessment with Sonography in Trauma, thoracic, vascular, ultrasound-guided puncture, echocardiography and undifferentiated shock diagnostic ultrasound at baseline, training completion and 1 month after training. We also measured the performance skills at the time of training completion. The relative value of the new curriculum was evaluated by differences in the confidence and performance measurements, with control for baseline measurements and confounding characteristics in univariate analyses and multivariate linear regression models. Results After training, both groups of trainees reported significantly increased self-confidence in performing POCUS as compared with baseline. Trainees with the new curriculum had statistically significant higher self-confidence increase and performance scores (p < 0.05), e.g., increase in confidence for diagnosis of undifferentiated shock at training completion = 3.14 vs. 1.85, 1 month after training = 2.22 vs. 1.56, for new and traditional curriculum, respectively. The new curriculum also resulted in a higher number of shock POCUS done within 1 month after training: 1.73 vs. 0, and higher overall performance scores: 165 vs. 113. The findings were robust when controlling for imbalanced baseline characteristics in multivariate regression models. Conclusion We conclude that a goal-directed, intensive but brief ED POCUS curriculum significantly increases trainee self-confidence, performance, and promote trainees to perform more procedures.
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Affiliation(s)
- Di Shi
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Jihai Liu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
| | - Jun Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Xuezhong Yu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
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27
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Royse C, Canty D, Sessler D. Perioperative ultrasound-assisted clinical evaluation - A case based review. Australas J Ultrasound Med 2018; 21:204-218. [PMID: 34760525 PMCID: PMC8409857 DOI: 10.1002/ajum.12113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Ultrasound is increasingly being adopted into anaesthesia and intensive care practice. The range of ultrasound examination has also increased from transoesophageal echocardiography in cardiac surgery and ultrasound-guided nerve blocks and vascular access, to examination of the heart, lungs, abdomen and deep veins. Typically, the use of ultrasound is focused or basic, designed to be performed by the anaesthetist at the patient's bedside in real time to answer clinical questions and to direct therapy. Ultrasound is not performed in isolation, but used to complement clinical evaluation, and accordingly can be considered as 'ultrasound-assisted perioperative evaluation'. Whilst there is good evidence that ultrasound improves diagnostic accuracy and in turn alters management, there are few data examining whether ultrasound leads to improved clinical outcomes. This review will examine multiple uses of perioperative ultrasound with case studies to illustrate potential utility.
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Affiliation(s)
- Colin Royse
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
| | - David Canty
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
- Department of MedicineMonash UniversityScenic Blvd & Wellington RoadClaytonVictoria3050Australia
- Department of Anaesthesia and Perioperative Medicine3rd FloorMonash Medical Centre246 Clayton RoadMelbourneVictoria3168Australia
| | - Daniel Sessler
- Department of Outcomes ResearchAnesthesiology InstituteCleveland ClinicClevelandOhioUSA
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Ketelaars R, Reijnders G, van Geffen GJ, Scheffer GJ, Hoogerwerf N. ABCDE of prehospital ultrasonography: a narrative review. Crit Ultrasound J 2018; 10:17. [PMID: 30088160 PMCID: PMC6081492 DOI: 10.1186/s13089-018-0099-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/25/2018] [Indexed: 02/08/2023] Open
Abstract
Prehospital point-of-care ultrasound used by nonradiologists in emergency medicine is gaining ground. It is feasible on-scene and during aeromedical transport and allows health-care professionals to detect or rule out potential harmful conditions. Consequently, it impacts decision-making in prioritizing care, selecting the best treatment, and the most suitable transport mode and destination. This increasing relevance of prehospital ultrasonography is due to advancements in ultrasound devices and related technology, and to a growing number of applications. This narrative review aims to present an overview of prehospital ultrasonography literature. The focus is on civilian emergency (trauma and non-trauma) setting. Current and potential future applications are discussed, structured according to the airway, breathing, circulation, disability, and environment/exposure (ABCDE) approach. Aside from diagnostic implementation and specific protocols, procedural guidance, therapeutic ultrasound, and challenges are reviewed.
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Affiliation(s)
- Rein Ketelaars
- Radboud Institute for Health Sciences, Department of Anesthesiology, Pain, and Palliative Medicine, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Radboud Institute for Health Sciences, Helicopter Emergency Medical Service Lifeliner 3, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Gabby Reijnders
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Geert-Jan van Geffen
- Radboud Institute for Health Sciences, Department of Anesthesiology, Pain, and Palliative Medicine, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Helicopter Emergency Medical Service Lifeliner 3, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Gert Jan Scheffer
- Radboud Institute for Health Sciences, Department of Anesthesiology, Pain, and Palliative Medicine, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nico Hoogerwerf
- Radboud Institute for Health Sciences, Department of Anesthesiology, Pain, and Palliative Medicine, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Helicopter Emergency Medical Service Lifeliner 3, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Abstract
Over the last decade there has been increasing interest and enthusiasm in point-of-care ultrasound (POCUS) as an aide to traditional examination techniques in assessing acutely unwell adult patients. However, it currently remains the domain of a relatively small handful of physicians within the UK. There are numerous reasons for this, notably a lack of training pathways and supervisors but also a lack of understanding of the evidence base behind this imaging modality. This review article aims to explore some of the evidence base behind POCUS for a number of medical pathologies, and where possible compare it to evidenced traditional examination techniques. We discuss the issues around training in bedside ultrasound and recommend a push to integrate POCUS training into internal medicine curricula and support trainers to comprehensively deliver this.
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Swerts F, Mathonet PY, Ghuysen A, D Orio V, Minon JM, Tonglet M. Early identification of trauma patients in need for emergent transfusion: results of a single-center retrospective study evaluating three scoring systems. Eur J Trauma Emerg Surg 2018; 45:681-686. [PMID: 29855669 DOI: 10.1007/s00068-018-0965-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Trauma-Induced Coagulopathy Clinical Score (TICCS) was developed to be calculable on the site of injury to discriminate between trauma patients with or without the need for damage control resuscitation and thus transfusion. This early alert could then be translated to in-hospital parameters at patient arrival. Base excess (BE) and ultrasound (FAST) are known to be predictive parameters for emergent transfusion. We emphasize that adding these two parameters to the TICCS could improve the scoring system predictability. METHODS A retrospective study was conducted in the University Hospital of Liège. TICCS was calculated for every patient. BE and FAST results were recorded and points were added to the TICCS according to the TICCS.BE definition (+ 3 points if BE < - 5 and + 3 points in case of a positive FAST). Emergent transfusion was defined as the use of at least one blood product in the resuscitation room. The capacity of the TICCS, the TICCS.BE and the Trauma-Associated Severe Hemorrhage (TASH) to predict emergent transfusion was assessed. RESULTS A total of 328 patients were included. Among them, 14% needed emergent transfusion. The probability for emergent transfusion grows with the TICCS and the TICCS.BE values. We did not find a significant difference between the TICCS (AUC 0.73) and the TICCS.BE (AUC 0.76). The TASH proved to be more predictive (AUC 0.89). 66.6% of the patients with a TICCS ≥ 10 and 81.5% with a TICCS.BE ≥ 14 required emergent transfusion. CONCLUSION Adding BE and FAST to the original TICCS does not significantly improve the scoring system predictability. A prehospital TICCS > 10 could be used as a trigger for emergent transfusion activation. TASH could then be used at hospital arrival. Prehospital TASH calculation may be possible but should be further investigated. LEVEL OF EVIDENCE Diagnostic test, level III.
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Affiliation(s)
| | | | | | | | - Jean Marc Minon
- CHR de la Citadelle, Laboratoire et service de transfusion, Liège, Belgium
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Desai N, Harris T. Extended focused assessment with sonography in trauma. BJA Educ 2017; 18:57-62. [PMID: 33456811 DOI: 10.1016/j.bjae.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- N Desai
- Department of Anaesthetics, St George's Hospital, London, UK
| | - T Harris
- Emergency Medicine, Barts Health NHS Trust and the Queen Mary University of London, Royal London Hospital, Whitechapel, London, UK
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Petrosoniak A, Hicks C. Resuscitation Resequenced: A Rational Approach to Patients with Trauma in Shock. Emerg Med Clin North Am 2017; 36:41-60. [PMID: 29132581 DOI: 10.1016/j.emc.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Trauma resuscitation is a complex and dynamic process that requires a high-performing team to optimize patient outcomes. More than 30 years ago, Advanced Trauma Life Support was developed to formalize and standardize trauma care; however, the sequential nature of the algorithm that is used can lead to ineffective prioritization. An improved understanding of shock mandates an updated approach to trauma resuscitation. This article proposes a resequenced approach that (1) addresses immediate threats to life and (2) targets strategies for the diagnosis and management of shock causes. This updated approach emphasizes evidence-based resuscitation principles that align with physiologic priorities.
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Affiliation(s)
- Andrew Petrosoniak
- Department of Emergency Medicine, St. Michael's Hospital, 1-008c Shuter Wing, 30 Bond street, Toronto, Ontario M5B 1W8, Canada.
| | - Christopher Hicks
- Department of Emergency Medicine, St. Michael's Hospital, 1-008c Shuter Wing, 30 Bond street, Toronto, Ontario M5B 1W8, Canada
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Little G. Accidental hypothermic cardiac arrest and rapid mediastinal warming with pleural lavage: a survivor after 3.5 hours of manual CPR. BMJ Case Rep 2017; 2017:bcr-2017-220900. [PMID: 28754760 DOI: 10.1136/bcr-2017-220900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old man suffered post-traumatic hypothermic cardiac arrest. On arrival in the emergency department, rectal core temperature was 23°C. Manual cardiopulmonary resuscitation (CPR) was continued as no mechanical chest compression device was available, and active and passive rewarming was undertaken. Bilateral thoracostomies confirmed good lung inflation. Defibrillation and intravenous epinephrine were discontinued until core temperature was elevated above 30°C. Extracorporeal rewarming was unavailable. When no increase in rectal temperature was achieved after 90 min, an alternative oesophageal probe confirmed mediastinal temperature as 23°C. Bilateral chest drain insertion, followed by microwave-heated saline pleural lavage, rapidly raised the oesophageal temperature above 30°C with subsequent successful defibrillation, initially to pulseless electrical activity and finally return of spontaneous circulation 3.5 hours after the commencement of CPR. The patient recovered fully and was discharged without neurological deficit. Rapid mediastinal warming with pleural lavage should be considered in units with no access to extracorporeal rewarming service.
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Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, Tancredi DJ, Kuppermann N. Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial. JAMA 2017; 317:2290-2296. [PMID: 28609532 PMCID: PMC5815005 DOI: 10.1001/jama.2017.6322] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown. OBJECTIVE To determine if the FAST examination during initial evaluation of injured children improves clinical care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center. INTERVENTIONS Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone. MAIN OUTCOMES AND MEASURES Coprimary outcomes were rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. RESULTS Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95% CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95% CI, 66% to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95% CI, 0.44% to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95% CI, -8.7% to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95% CI, -0.6% to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95% CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95% CI, -$6651 to $4291). CONCLUSIONS AND RELEVANCE Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01540318.
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Affiliation(s)
- James F. Holmes
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | - Kenneth M. Kelley
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | | | - Garth H. Utter
- Department of Surgery, University of California, Davis School of Medicine, Sacramento
| | - Lisa P. Abramson
- Department of Surgery, University of California, Davis School of Medicine, Sacramento
| | - John S. Rose
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
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Dammers D, El Moumni M, Hoogland II, Veeger N, Ter Avest E. Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2017; 25:1. [PMID: 28049498 PMCID: PMC5210260 DOI: 10.1186/s13049-016-0342-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/06/2016] [Indexed: 11/14/2022] Open
Abstract
Background Focussed Assessment with Sonography for Trauma (FAST) is a bedside ultrasonography technique used to detect free intraperitoneal fluid in patients presenting with blunt abdominal trauma (BAT) in the emergency department. Methods In this retrospective cohort study we investigated the potential of FAST as a risk stratification instrument in haemodynamically (HD) stable patients presenting after BAT by establishing the association between the FAST exam result and final outcome. An adverse outcome was defined in this context as the need for either a laparoscopy/laparotomy or an angiographic embolization or death due to abdominal injuries). Results A total of 421 patients with BAT were included, of which nine had an adverse outcome (2%). FAST was negative in 407 patients. Six of them turned out to have free intraperitoneal fluid (sensitivity 67 [41–86]%). FAST was positive in 14 patients, 12 of whom had free intraperitoneal fluid (specificity 99 [98–100]%). A positive FAST (positive likelihood ratio 34.3 [15.1–78.5]) was stronger associated with an adverse outcome than Injury Severity Score (ISS) or any individual clinical- or biochemical variables measured at presentation in the ED. Discussion The FAST exam can provide valuable prognostic information at minimal expenses during the early stages of resuscitation in haemodynamically stable patients presenting with BAT. Conclusions FAST exam should not be omitted in patients with BAT. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0342-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Dammers
- Department of Emergency Medicine, Medical Center Leeuwarden, Henry Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - M El Moumni
- Department of Trauma surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I I Hoogland
- Medical Student, University of Groningen, Groningen, The Netherlands
| | - N Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen and Medical Center Leeuwarden, Groningen, The Netherlands
| | - E Ter Avest
- Department of Emergency Medicine, Medical Center Leeuwarden, Henry Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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Abstract
BACKGROUND Injury to the abdomen can be blunt or penetrating. Abdominal injury can damage internal organs such as the liver, spleen, kidneys, intestine, and large blood vessels. There are controversies about the best approach to manage abdominal injuries. OBJECTIVES To assess the effects of surgical and non-surgical interventions in the management of abdominal trauma in a haemodynamically stable and non-peritonitic abdomen. SEARCH METHODS We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic+EMBASE (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), CINAHL Plus (EBSCO), and clinical trials registers, and screened reference lists. We ran the most recent search on 17 September 2015. SELECTION CRITERIA Randomised controlled trials of surgical interventions and non-surgical interventions involving people with abdominal injury who were haemodynamically stable with no signs of peritonitis. The abdominal injury could be blunt or penetrating. DATA COLLECTION AND ANALYSIS Two review authors independently applied the selection criteria. Data were extracted by two authors using a standard data extraction form, and are reported narratively. MAIN RESULTS Two studies are included, which involved a total of 114 people with penetrating abdominal injuries. Both studies are at moderate risk of bias because the randomisation methods are not fully described, and the original study protocols are no longer available. The studies were undertaken in Finland between 1992 and 2002, by the same two researchers.In one study, 51 people were randomised to surgery or an observation protocol. None of the participants in the study died. Seven people had complications: 5 (18.5%) in the surgical group and 2 (8.3%) in the observation group; the difference was not statistically significant (P = 0.42; Fischer's exact). Among the 27 people who had surgery, 6 (22.2%) surgeries were negative laparotomies, and 15 (55.6%) were non-therapeutic.In the other study, 63 people were randomised to diagnostic laparoscopy (surgery) or an observation protocol. There were no deaths and no unnecessary surgeries in either group. Four people did not receive the intervention they were assigned. There was no difference in therapeutic operations between the two groups: 3 of 28 in the diagnostic laparoscopy group versus 1 of 31 in the observation protocol group (P = 0.337). AUTHORS' CONCLUSIONS Based on the findings of 2 studies involving a total of 114 people, there is no evidence to support the use of surgery over an observation protocol for people with penetrating abdominal trauma who have no signs of peritonitis and are stable.
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Affiliation(s)
- Angela Oyo-Ita
- Department of Community Health, University of Calabar Teaching Hospital, PMB 1278, Calabar, Nigeria
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