Point of Care Ultrasound Literature Primer: Key Papers on Focused Assessment With Sonography in Trauma (FAST) and Extended FAST

Kim, Daniel; Bell, Colin; Jelić, Tomislav; Sheppard, Gillian; Robichaud, Laurie; Burwash-Brennan, Talia; Chenkin, Jordan; Lalande, Élizabeth; Buchanan, Ian; Atkinson, Paul; Thavanathan, Rajiv; Heslop, Claire; Myslik, Frank; Lewis, David A.

doi:10.7759/cureus.30001

Cited by 4 publications

(9 citation statements)

References 35 publications

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“…This is part of an ongoing series to identify the most influential papers for each major application or use of POCUS. We applied the same study design and protocol we previously described in the initial paper of this series [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…We described our modified Delphi process in the initial publication of this series [ 8 ]. To briefly summarize, in round one, participants nominated five to 10 papers they considered the most influential for renal POCUS and five to 10 papers for biliary POCUS.…”

Section: Methodsmentioning

confidence: 99%

“…The POCUS literature base continues to grow at a dramatic rate [6,7]. Although many important POCUS papers have been published, there are very few publications that have systematically identified the most influential papers in this field [8]. The objective of this series is to systematically generate a list of papers for each major application or use of POCUS.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The objective of this series is to systematically generate a list of papers for each major application or use of POCUS. The first publication in this series identified the top five influential papers published on focused assessment with sonography in trauma (FAST) and extended FAST (E-FAST) [ 8 ]. Such a resource is useful to educate residents, fellows, and engaged physicians on the literature base supporting their use of POCUS as well as to inform clinicians in all specialties on how to use POCUS in an evidence-based manner.…”

Section: Introductionmentioning

confidence: 99%

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Point-of-Care Ultrasound (POCUS) Literature Primer: Key Papers on Renal and Biliary POCUS

Kim¹,

Bell²,

Jelić³

et al. 2023

Cureus

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The objective of this study is to identify the top five influential papers published on renal point-of-care ultrasound (POCUS) and the top five influential papers on biliary POCUS in adult patients. MethodsA 14-member expert panel was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. All panel members have had ultrasound fellowship training or equivalent, are actively engaged in POCUS scholarship, and are involved with POCUS at their local site and nationally in Canada. We used a modified Delphi process consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five influential papers for renal POCUS and biliary POCUS. ResultsThe panel identified 27 relevant papers on renal POCUS and 30 relevant papers on biliary POCUS. All panel members participated in all three rounds of the modified Delphi process, and after completing this process, we identified the five most influential papers on renal POCUS and the five most influential papers on biliary POCUS. ConclusionWe have developed a list, based on expert opinion, of the top five influential papers on renal and biliary POCUS to better inform all trainees and clinicians on how to use these applications in a more evidencebased manner. This list will also be of interest to clinicians and researchers who strive to further advance the field of POCUS.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Point-of-Care Ultrasound (POCUS) Literature Primer: Key Papers on Renal and Biliary POCUS

Kim¹,

Bell²,

Jelić³

et al. 2023

Cureus

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Implementation of Point of Care Ultrasound in extended focused assessment with sonography for trauma at a rural hospital in Uganda

Nassanga,

Bugeza,

Faith

et al. 2023

Preprint

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IntroductionFocused Assessment with Sonography for Trauma (FAST) is a rapid bedside ultrasound examination performed at presentation of a trauma patient whereas the extended FAST (eFAST) examines each hemithorax for the presence of free fluid and air. It is an ‘extension’ of the trauma clinical assessment process and aids rapid diagnosis with an aim of identifying free peritoneal fluid which allows for immediate transfer to theatre or further imaging. FAST can be performed by surgeons, emergency physicians, and paramedics as a screening test to detect post-traumatic pericardial effusion or hemoperitoneum, performed at presentation of a trauma patient.ObjectiveThe purpose of this study was to evaluate the feasibility of implementing a point of care ultrasound training in trauma for non-imaging health professionals and evaluate the ability of the trainees to apply the knowledge and skills gained to perform the ultrasound examination among trauma patients.MethodsIt was a prospective cohort study conducted at Kiwoko hospital, a rural based hospital in Uganda. The study involved developing a curriculum and training of clinicians in point of care ultrasound for trauma patients through didactic lectures and practical sessions as well as assessing them at baseline and thereafter further assessment at three months follow up.ResultsA total of 19 clinicians were initially enrolled however, 12 were evaluated at baseline and nine were followed up for three months. The median length of time in clinical practice of the clinicians in this study was 11(2-36) months. At baseline, majority of the clinicians correctly identified and named all the anatomical structures pertinent to images obtained in eFAST; sub-xiphoid view 7(58.3%), right upper quadrant view 5(41.7%), left upper quadrant view 6(50.0%), suprapubic view 7(58.3%), thoracic-pleural fluid view 7(58.3%), and thoracic-pneumothorax view 4(33.3%). At follow-up, the clinicians demonstrated acceptable competency in ultrasound technique when performing eFAST in most views assessed. However, compared to the baseline observation, a statistically significant decline (p=0.001) in image quality was noted in evaluation of organs in the left upper quadrant.ConclusionClinicians generally demonstrated acceptable competency in performing eFAST assessment in trauma patients. With more training, frequent hands-on practice, regulation and adequate supervision, clinicians can ably perform eFAST procedures to aid in management of trauma patients.

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Are Chest Radiographs or Ultrasound More Accurate in Predicting a Pneumothorax or Need for a Thoracostomy Tube in Trauma Patients?

DeLoach

Reif

Smedley

et al. 2023

The American Surgeon™

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Background Historically, chest radiographs (CXR) have been used to quickly diagnose pneumothorax (PTX) and hemothorax in trauma patients. Over the last 2 decades, chest ultrasound (CUS) as part of Extended Focused Assessment with Sonography in Trauma (eFAST) has also become accepted as a modality for the early diagnosis of PTX in trauma patients. Methods We queried our institution’s trauma databases for all trauma team activations from 2021 for patients with eFAST results. Demographics, injury variables, and the following were collected: initial eFAST CUS, CXR, computed tomography (CT) scan, and thoracostomy tube procedure notes. We then compared PTX detection rates on initial CXR and CUS to those on thoracic CT scans. Results 580 patients were included in the analysis after excluding patients without a chest CT scan within 2 hours of arrival. Extended Focused Assessment with Sonography in Trauma was 68.4% sensitive and 87.5% specific for detecting a moderate-to-large PTX on chest CT, while CXR was 23.5% sensitive and 86.3% specific. Extended Focused Assessment with Sonography in Trauma was 69.8% sensitive for predicting the need for tube thoracostomy, while CXR was 40.0% sensitive. Discussion At our institution, eFAST CUS was superior to CXR for diagnosing the presence of a PTX and predicting the need for a thoracostomy tube. However, neither test is accurate enough to diagnose a PTX nor predict if the patient will require a thoracostomy tube. Based on the specificity of both tests, a negative CXR or eFAST means there is a high probability that the patient does not have a PTX and will not need a chest tube.

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Point of Care Ultrasound Literature Primer: Key Papers on Focused Assessment With Sonography in Trauma (FAST) and Extended FAST

Cited by 4 publications

References 35 publications

Point-of-Care Ultrasound (POCUS) Literature Primer: Key Papers on Renal and Biliary POCUS

Point-of-Care Ultrasound (POCUS) Literature Primer: Key Papers on Renal and Biliary POCUS

Implementation of Point of Care Ultrasound in extended focused assessment with sonography for trauma at a rural hospital in Uganda

Are Chest Radiographs or Ultrasound More Accurate in Predicting a Pneumothorax or Need for a Thoracostomy Tube in Trauma Patients?

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