Ultrasonography in trauma: a nation-wide cross-sectional investigation

Abstract

BackgroundThe Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark.MethodsWe conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation of existing guidelines, and the second phase was a series of structured interviews of orthopedic surgeons, anesthesiologists, and radiologists on call in all hospitals receiving traumatized patients in Denmark.ResultsGuidelines were obtained from all 22 hospitals receiving traumatized patients in Denmark. Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST indications varied between circulatory instability n = 8 (36.4%), team leader’s discretion n = 6 (27.3%), abdominal trauma n = 3 (13.6%), and not specified n = 6 (27.3%). Telephone interviews revealed that exams were always n = 8 (36.4%) or often n = 4 (18.2%) registered in the patients’ charts. The remaining n = 10 (45.5%) facilities either never registered n = 2 (9.1%), it was not possible to register n = 1 (4.5%), or unknown by the trauma leaders n = 7 (31.8%). Images were often stored in n = 1 (4.5%), never stored in n = 10 (45.5%), not possible to store in n = 2 (9.1%), and unknown in n = 9 (40.9%) facilities.ConclusionUltrasonography was used in a non-uniform fashion by multiple specialties in Danish trauma facilities. Very few images from FAST examinations were stored and documentation was scanty. National guidelines on application and documentation of ultrasonography in trauma are called for.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-017-0071-2) contains supplementary material, which is available to authorized users.

Anatomical locations of air for rapid diagnosis of pneumothorax in blunt trauma patients

“…2 and 3) which will help in early detection of small pneumothoraces. In contrast with other studies [5, 18], our study has shown that the lateral sites had the least probabilities for the presence of air pockets. Moreover, the presence of air at these sites indicates large pneumothorax volume (more than 500 mL).…”

“…This method is time-consuming and less practical in trauma setting as it wastes a critical time needed for the management of other serious injuries. Other studies, based on the assumption that air will accumulate anteriorly in supine patients, have recommended US scanning the chest in one or two positions: either anterior at the second intercostal space in the midclavicular line [16, 17] and/or at the anterolateral chest wall at the 4th or 5th intercostal space at midaxillary line [5, 18].…”

Disease relevance of rare VPS13B missense variants for neurodevelopmental Cohen syndrome

“…This idea can be extended for AR rare pathogenic missense variants. Here, random clusters may support the identification of critical molecular regions 33 , 34 . For VPS13B no clustering of neither loss-of-function nor missense variants could be recognized so far 8 .…”

Current status of point of care ultrasonography for the perioperative care of trauma patients

“…It is useful in providing rapid and noninvasive evaluation for pneumothorax [30,31], pulmonary edema [32], atelectasis, effusion, and pneumonia. It has been demonstrated to be useful in a prehospital setting as well as intraoperatively during a polytrauma surgery [33]. Given its small size and portability, POCUS has been utilized in both helicopter and military settings to diagnose pneumothorax (PTX) [34,35].…”