An abdominal computed tomography may be safe in selected hypotensive trauma patients with positive Focused Assessment with Sonography in Trauma examination

Cook, Mackenzie R.; Rahbar, Mohammad Hossein; Fox, Erin E.; Junco, Deborah J. del; Wade, Charles E.; Zhang, Jiajie; Matijevic, Nena; Bai, Yu; Wang, Weiwei; Podbielski, Jeanette; Duran, Sarah J.; Benjamin-Garner, Ruby; Reynolds, Robert J.; Zhang, Xuan; Dickerson, Aisha S.; Camp, Elizabeth S.; Holcomb, John B.; Cotton, Bryan A.; Elopre, Marily; Hatch, Quinton; Scerbo, Michelle H.; Caga-Anan, Zerremi; White, Christopher E.; Franzen, Kimberly L.; Coates, Elsa C; Brasel, Karen J.; Walsh, Pamela; Schreiber, Martin A.; Underwood, Samantha J.; Curren, Jodie; Cohen, Mitchell J.; Knudson, M. Margaret; Nelson, Mary F.; Call, Mariah S.; Muskat, Peter; Johannigman, Jay A.; Branson, Richard D.; Gomaa, Dina; Dahl, Cendi; Alarcon, Louis H.; Peitzman, Andrew B.; Stull, Stacy; Kampmeyer, Mitch; Early, Barbara J.; Shnol, Helen L.; Zolin, Samuel J.; Sears, Sarah; Myers, John G.; Stewart, Ronald M.; Sambucini, Rick L.; Gildea, Marianne Reid; DeRosa, Mark; Jonas, Rachelle B.; McCarthy, Janet; Phelan, Herbert; Minei, Joseph P.; Carroll, Emily; Bulger, Eileen M.; Klotz, Patricia; Warner, Keir J.

doi:10.1016/j.amjsurg.2015.01.005

Cited by 13 publications

(4 citation statements)

References 31 publications

(30 reference statements)

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“…The present study also showed that the proportions of patients undergoing initial CT gradually increased between 2004 and 2016. The usefulness of CT in emergency medical settings for trauma has been documented 23. A multicentre observational study showed that CT was associated with a reduction in emergency surgery 23.…”

Section: Discussionmentioning

confidence: 99%

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Initial focused assessment with sonography in trauma versus initial CT for patients with haemodynamically stable torso trauma

et al. 2019

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ObjectiveFocused assessment with sonography in trauma (FAST) examination is a widely known initial evaluation for patients with trauma. However, it remains unclear whether FAST contributes to patient survival in patients with haemodynamically stable trauma. In this study, we compared in-hospital mortality and length of stay between patients undergoing initial FAST vs initial CT for haemodynamically stable torso trauma.MethodsThis was a retrospective cohort study using data from 264 major emergency hospitals in the Japan Trauma Data Bank between 2004 and 2016. Patients were included if they had torso trauma with a chest or abdomen abbreviated injury scale score of ≥3 and systolic blood pressure of ≥100 mm Hg at hospital arrival. Eligible patients were divided into those who underwent initial FAST and those who underwent initial CT. Multivariable logistic regression analysis for in-hospital mortality and multivariable linear regression for length of stay were performed to compare the initial FAST and initial CT groups with adjustment for patient backgrounds while also adjusting for within-hospital clustering using a generalised estimating equation.ResultsThere were 9942 patients; 8558 underwent initial FAST and 1384 underwent initial CT. Multivariable logistic regression showed no significant difference in in-hospital mortality between the initial FAST and initial CT groups (OR 1.37, 95% CI 0.94 to 1.99, p=0.10). Multivariable linear regression revealed that the initial FAST group had a significantly longer length of stay than the initial CT group (difference: 3.5 days; 95% CI 1.0 to 5.9, p<0.01).ConclusionsIn-hospital mortality was not significantly different between the initial FAST and initial CT groups for patients with haemodynamically stable torso trauma. Initial CT should be considered in patients with haemodynamically stable torso trauma.

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Section: Discussionmentioning

confidence: 99%

“…The usefulness of CT in emergency medical settings for trauma has been documented 23. A multicentre observational study showed that CT was associated with a reduction in emergency surgery 23. CT has become more common in trauma care and is now easy to access in most emergency departments.…”

Section: Discussionmentioning

confidence: 99%

Initial focused assessment with sonography in trauma versus initial CT for patients with haemodynamically stable torso trauma

et al. 2019

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“…Focused assessment sonograph for trauma (FAST) is a medically proven method for the initial evaluation of closed intra-abdominal injuries. The portable ultrasound diagnostic system takes less time than traditional ultrasound and CT and is more mobile than CT and conventional ultrasound in terms of accuracy and sensitivity in exploring the abdominal cavity, with no significant differences [46]. It can be repeatedly and continuously examined, and the change in the amount of fluid and blood can be examined in a dynamic situation, which facilitates the examination and medical judgment of the disease [47].…”

Section: Application Of Portable Intelligent Ultrasound In the Diagno...mentioning

confidence: 99%

Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites

Gao,

Lv,

Hou

2023

Diagnostics

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With the miniaturization of ultrasound and the development of artificial intelligence, its application in disaster scenes and pre-hospital emergency care has become more and more common. This study summarizes the literature on portable ultrasound in pre-hospital emergency and disaster scene treatment in the past decade and reviews the development and application of portable ultrasound. Portable ultrasound diagnostic equipment can be used to diagnose abdominal bleeding, limb fracture, hemopneumothorax, pericardial effusion, etc., based on which trauma can be diagnosed pre-hospital and provide guiding suggestions for the next triage and rescue; in early rescue, portable ultrasound can guide emergency operations, such as tracheal intubation, pericardial cavity puncture, and thoracic and abdominal puncture as well as improve the accuracy and timeliness of operation techniques. In addition, with the development of artificial intelligence (AI), AI-assisted diagnosis can improve the diagnosis level of ultrasound at disaster sites. The portable ultrasound diagnosis system equipped with an AI robotic arm can maximize the pre-screening classification and fast and concise diagnosis and treatment of batch casualties, thus providing a reliable basis for batch casualty classification and evacuation at disaster accident sites.

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“…ст. и ниже, у которых была обнаружена внутрибрюшная жидкость при FAST, привело к уменьшению частоты экстренных лапаротомий с 93% до 22% и увеличению частоты ангиографических эмболизаций с 2% до 22% [14].…”

Section: тактика целенаправленной лучевой диагностикиunclassified

Tactics of Primary Emergency Radiation Diagnosis of Politrauma

Шапкин

Seliverstov

Стекольников

2021

Vestn. rentgenol. radiol.

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The review considers the problem of choosing the optimal tactical approach to primary emergency radiation diagnosis of injuries during polytrauma based on data on indications for use, advantages and disadvantages of modern methods and protocols of radiation imaging. Literary sources were searched in the MedLine/ PubMed and eLibrary databases published from 2009 to 2019.The tactics of selective radiation diagnosis of polytrauma involves performing sequential studies (sonography, X-ray, computed tomography) of body areas in which damage is suspected by the mechanism of injury and clinical data, which limits the accuracy of the diagnosis and increases the duration of the examination. Primary multi-helical “whole-body”computed tomography including head, neck, chest, abdomen and pelvis examination, reduces the percentage of missed injuries, the duration of the examination and the time before emergency surgery, which can significantly reduce mortality in polytrauma. Its use is justified in patients with severe combined trauma if a high level of emergency hospital care organization is provided. Using “whole-body” computed tomography significantly increases the dose and economic costs, but the benefits of it for the survival of patients with polytrauma can outweigh the radiation risk and economic losses. Further development of technologies and protocols for multispiral computed tomography can significantly reduce the dose of radiation and the duration of the study. Clear and well-founded criteria for the selection of patients are needed for whom the use of “whole-body” computed tomography will be an effective strategy for radiation diagnosis.

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An abdominal computed tomography may be safe in selected hypotensive trauma patients with positive Focused Assessment with Sonography in Trauma examination

Cited by 13 publications

References 31 publications

Initial focused assessment with sonography in trauma versus initial CT for patients with haemodynamically stable torso trauma

Initial focused assessment with sonography in trauma versus initial CT for patients with haemodynamically stable torso trauma

Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites

Tactics of Primary Emergency Radiation Diagnosis of Politrauma

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