Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

Stengel, Dirk; Bauwens, Kai; Sehouli, Jalid; Rademacher, G.; Mutze, Sven; Porzsolt, Franz

doi:10.1002/14651858.cd004446.pub2

Cited by 57 publications

(36 citation statements)

References 28 publications

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“…17,25,33–35,41,49 While we did not review studies of clinical outcomes, a Cochrane systematic review found that ultrasound-based patient management algorithms reduced CT ordering by 50%. 57 …”

Section: Limitationsmentioning

confidence: 99%

Does This Adult Patient Have a Blunt Intra-abdominal Injury?

Nishijima

Simel

Wisner

et al. 2012

JAMA

139

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A 25-year-old man was a restrained passenger in a high-speed motor vehicle collision. He reports abdominal pain, which he attributes to his lap restraint belt. He is hemodynamically stable with a blood pressure of 120/75 mm Hg and a pulse of 88/min. Physical examination reveals a transverse area of erythema and ecchymosis consistent with the lap restraint belt, and the patient has mild suprapubic tenderness on abdominal palpation (FIGURE 1). Case 2A 55-year-old man fell 8 ft from a ladder onto the ground. He is hemodynamically stable with a blood pressure of 132/72 mm Hg and a pulse of 76/ min. Physical examination reveals bruising and tenderness to the right costal margin and abrasions along the right flank but no tenderness with palpation over his abdomen. Laboratory testing demonstrates normal hematocrit, white blood cell (WBC) count, and liver transaminases and absence of hematuria. WHY IS THIS QUESTION IMPORTANT?Trauma is the leading cause of death in those younger than 45 years in the CME available online at www.jamaarchivescme.com and questions on p 1536.

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Section: Limitationsmentioning

confidence: 99%

Does This Adult Patient Have a Blunt Intra-abdominal Injury?

Nishijima

Simel

Wisner

et al. 2012

JAMA

139

View full text Add to dashboard Cite

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“…the focused assessment with sonography in trauma [FAST] examination in blunt abdominal trauma). 14 Kim et al 15 question the 'uncritical acceptance' of the diagnostic role of POCUS, which they believe is 'spurred by enthusiasm, not science'.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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IntroductionPoint-of-care ultrasound (POCUS) use in clinical care is growing rapidly, and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. In this study, we conducted a critical and systematic review framed by the rationales enumerated by advocates of ultrasound in UME in academic publications. MethodsThis research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified using techniques from Foucauldian critical discourse analysis (CDA) from an archive of 403 academic publications. We then sought empirical evidence in support of theses rationales, using a critical synthesis methodology also adapted from CDA. ResultsWe identified four dominant discursive rationales, with different levels of evidentiary support. Ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent, and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve quality of patient care was difficult to evaluate. DiscussionOur analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimizes them and may preclude further primary research. Since the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

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“…However, the importance of this technology in early trauma management remains controversial. Besides its cost and the risk of radiation exposure, whole-body CT raises safety concerns about time delays due to patient transportation from the emergency room to the CT room and scanning [1-3]. …”

Section: Introductionmentioning

confidence: 99%

Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

et al. 2012

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IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.ResultsIn total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups.ConclusionsDiagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.

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Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

Abstract: There is insufficient evidence from RCTs to justify promotion of ultrasound-based clinical pathways in diagnosing patients with suspected blunt abdominal trauma.

Cited by 57 publications

References 28 publications

Does This Adult Patient Have a Blunt Intra-abdominal Injury?

Does This Adult Patient Have a Blunt Intra-abdominal Injury?

Ultrasound in undergraduate medical education: a systematic and critical review

Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

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