Utility of ultrasonography in the triage of patients in the disaster setting: A preliminary study

Abstract

Study objectives: We determine whether focused abdominal sonography for trauma (FAST) might be a useful adjunct to simple triage and rapid treatment (START) in further triaging victims already classified as delayed. Methods: This was a retrospective chart review of all adult trauma patients evaluated by the trauma surgery service at a Level I trauma center between January 1 and December 31, 2003. All patients requiring trauma surgery evaluation were deemed nonambulatory. Patients with initial respiratory rate greater than 30 breaths/min, systolic blood pressure less than 80 mm Hg, or Glasgow Coma Scale (GCS) score of 13 or less were categorized as Immediate (Red). Individuals with a GCS score of 8 or less were categorized as Expectant (Black). All other patients were categorized as Delayed (Yellow). FAST results were obtained from the medical records. Under circumstances in which only abdominal computed tomography (CT) was obtained, results were extrapolated to a positive FAST if free fluid was noted in the abdomen, or more than a trivial pericardial effusion was noted. If FAST and CT results conflicted, the FAST results were used for the purpose of this study. Results: Five hundred of the 773 adult patients had either FAST, abdominal CT, or both recorded. The remainder of patients presented with isolated head injuries, orthopedic injuries, or penetrating trauma. Five of the 500 patients had data missing that precluded START classification. Forty-one (11.2%) of 367 Yellow patients had a positive FAST, whereas 11 (8.6%) of 128 Red/Black patients had a positive FAST ( P =.41, OR 1.34, 95% confidence interval [CI] 0.64 to 2.86). Pulse rate 110 beats/min or greater was not significantly associated with a positive FAST in either Yellow-triaged ( P =.74, OR 0.85, 95% CI 0.28 to 2.42) or Red/Black-triaged ( P =.48, OR 1.59, 95% CI 0.36 to 6.63) patients. Conclusion: Use of FAST ultrasonography might have detected 41 patients with intra-abdominal injury, potentially changing their triage level and expediting their care. No significant difference was noted between positive FAST rates in Red/Black-triaged and Yellow-triaged patients. Tachycardia in any triage category did not predict the presence of a positive FAST examination.