Abstract
BackgroundThe initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real “added value” of chest X-rays (CXRs) and pelvic X-rays (PXR), particularly in haemodynamically stable trauma patients. The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients.MethodsThis was a prospective, interventional, single-centre study including all primary blunt trauma patients admitted to the trauma bay with a suspicion of severe trauma. All patients underwent physical examination and eFAST (assessing abdomen, pelvis, pericardium and pleura) before a whole-body CT scan (WBCT). Patients fulfilling all stability criteria at any time in transit from the scene of the accident to the hospital were managed in the trauma bay without chest and PXR.ResultsAmongst 430 patients, 148 fulfilled the stability criteria (stability criteria group) of which 122 (82 %) had no X-rays in the trauma bay. No diagnostic failure with an immediate clinical impact was identified in the stability criteria group (SC group). All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group. The time spent in the trauma bay was significantly shorter for the SC group without X-rays compared to those who received any X-ray (25 [20; 35] vs. 38 [30; 60] min, respectively; p < 0.0001). An analysis of the cost and radiation exposure showed savings of 7000 Є and 100 mSv, respectively.ConclusionsNo unrecognized diagnostic with a clinical impact due to the lack of CXR and PXR during the initial management of stable trauma patients was observed. The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan. It allowed a sensible cost and radiation saving.
Highlights
The initial management of a trauma patient is a critical and demanding period
Intensive Care (2016) 6:62 performance of pleural ultrasonography is convincing and shows better results compared to chest X-ray (CXR), especially in the context of trauma [4, 5], where CXR is performed in the supine position due to the need for spine immobilization
The added value of CXR and pelvic X-rays (PXR) can be questioned in haemodynamically stable trauma patients when extended focused assessment sonography for trauma (eFAST) is used during the primary survey and a whole-body computed tomography (CT) (WBCT) scan in the secondary survey
Summary
The initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real “added value” of chest X-rays (CXRs) and pelvic X-rays (PXR), in haemodynamically stable trauma patients. The initial management of a trauma patient is a critical period combining at the same time the need to make a rigorous injury assessment, find sources of bleeding, stabilize vital functions and define a therapeutic strategy. This approach is outlined in the “advanced trauma life support” (ATLS) guidelines. The added value of CXR and PXR can be questioned in haemodynamically stable trauma patients when eFAST is used during the primary survey and a whole-body CT (WBCT) scan in the secondary survey
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