Ultrasound Based Key Clinical Pathway Reduces the use of Hospital Resources for the Evaluation of Blunt Abdominal Trauma

Branney, Scott W.; Moore, Ernest E.; Cantrill, Stephen V.; Burch, Jon M.; Terry, Shirley J.

doi:10.1097/00005373-199706000-00017

Cited by 137 publications

(70 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, smaller hospitals may not have CT as readily available; consequently, ultrasound would be important. Branney et al [26] developed a key clinical decision pathway using ultrasound in blunt trauma patients that reduced CT and DPL use and cost, without an increase in missed injuries. In addition, recent evidence in a randomized trial demonstrated that when ultrasound is absent, more abdominal CT scans were ordered, suggesting that some abdominal CT scans are being performed as ''screening'' tests, especially in patients with a low clinical probability of intra-abdominal injury [27].…”

Section: Clinical Implications Of the Focused Assessment With Sonogramentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound in abdominal trauma

Rose

2004

Emergency Medicine Clinics of North America

View full text Add to dashboard Cite

Ultrasound in the evaluation of abdominal trauma has evolved over the past 30 years. The use of ultrasound for abdominal trauma was described initially by Kristensen and colleagues [1] in 1971. In 1976, Ascher and colleagues [2] first reported the accuracy of ultrasound in Radiology, with 80% sensitivity for the detection of splenic injury. In a study of 808 patients, Tiling and colleagues [3] in 1990 reported a sensitivity of 89%, a specificity of 100%, and an accuracy of 98%. This same group also was first to comment on the effect of training and experience and reported that surgeons with extensive ultrasound experience could diagnose intra-abdominal fluid with a sensitivity of 96% and an accuracy of 99%. Interest and experience with ultrasound for trauma grew steadily around the world among surgeons and emergency physicians during the early 1990s [4][5][6][7]. During this period, ultrasound technology was improving with regard to price, portability, and resolution, allowing its use during resuscitation. At the same time, in the United States, there was continuing reliance on diagnostic peritoneal lavage (DPL) and CT and much less interest in sonography for abdominal trauma. This all changed when emergency physicians and surgeons in the United States began to publish their experience with ultrasound [4,8,9]. The term Focused Assessment with Sonography for Trauma (FAST) was coined by Rozycki et al [10] in 1996 and has persisted as the accepted acronym for the trauma ultrasound evaluation. The basic four-view examination (perihepatic, perisplenic, pelvic, and pericardial views) has become the foundation of the FAST examination. The rapid, noninvasive, and practical nature of ultrasound for bedside evaluation of critically injured patients has changed the evaluation of blunt abdominal trauma.

show abstract

Section: Clinical Implications Of the Focused Assessment With Sonogramentioning

confidence: 99%

“…Another algorithm that is more logical and incorporates clinical and ultrasound data is the Key Clinical Pathway developed by Branney et al [26]. This pathway uses hemodynamic status first.…”

Section: Clinical Algorithmsmentioning

confidence: 99%

Ultrasound in abdominal trauma

Rose

2004

Emergency Medicine Clinics of North America

View full text Add to dashboard Cite

show abstract

“…A study by Eanniello had only 16% of patients with positive CT findings who required a laparotomy. 16 Branney 17 found a 58% reduction in the use of CT using a protocol where haemodynamically unstable patients or those with signs of peritonitis with positive US findings underwent laparotomy, but those with negative US and normal physical examination were admitted for observation. The rate of missed injuries was not reported higher in those who did not have a CT. 3 It also had no impact on the duration of hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Wong¹,

Ngo

Wee³

et al. 2014

Hong Kong Journal of Emergency Medicine

View full text Add to dashboard Cite

Focused assessment with sonography in trauma (FAST): experience of a tertiary hospital in Southeast Asia創傷超聲重點評估（FAST）：東南亞一間三級醫院的經驗 E Wong 王怡玲, ASY Ngo 吳淑瑩, JCP Wee 黃俊評, JMH Lee 李美華 Objective: This study compares the positive predictive value (PPV) and negative predictive value (NPV) of focused assessment with sonography in trauma (FAST) versus abdominal-pelvic computed tomography scans (CTAP) after blunt abdominal injury as well as the need for abdominal surgery. We also sought to determine if any false negative ultrasound studies were associated with significant morbidity. The results were compared with other studies. Design: Retrospective cross-sectional study. Setting: A tertiary hospital. Methods: Cases were retrieved from the trauma registry and electronic medical records in a tertiary hospital in Singapore over a two year period from 1 January 2009 to 31 December 2010. Exclusion criteria included penetrating trauma and burns. The sonographic finding, computed tomography finding, and the outcome of the patients were retrieved. Diagnostic characteristics including predictive values were calculated. Results: A total of 476 patients were enrolled. Four hundred fifty-nine patients had FAST performed with fifty (10.9%) being positive. Forty-nine patients (21.7%) out of 226 patients had CTAP which showed abnormalities and nineteen (4.0%) patients underwent surgery. Comparing FAST to detect abnormalities on CTAP, the PPV and NPV were 0.590 and 0.863 respectively. Comparing FAST with the need for surgery, the PPV and NPV were 0.280 and 0.990 respectively. Four patients (0.98%) had negative FAST but required surgery. There were no significant adverse outcomes or surgical intervention in patients with normal vital signs, normal initial physical examination and negative FAST findings but who did not have a CTAP. Conclusions: In patients with an initial normal physical examination and negative FAST, emergent CTAP may be avoided. (Hong Kong j.emerg.med. 2014;21:230-236) 目的：本研究比較了創傷超聲重點評估（ FAST ）與腹腔 / 盆腔 CT 掃描（ CTAP ），在腹部閉合性損傷的陽性預測值（ P P V ）和陰性預測值（ NP V ），以及是否需要腹部手術。我們還試圖確定假陰性的超聲檢查，是否與有重大的併發症有關。並將結果與其他研究進行比較。設計：回顧性橫斷面研究。

show abstract

“…In order to detect pericardial, pleural with exam windows are used through which interior structures are imaged (2)(3)(4)(5)(6). In the setting of trauma, free intraabdominal or intrathoracic fluid indicates hemorhage (1,7,8). When compared to physical exam and CT imaging, bedside ultrasound is performed rapidly and assess accurate result in determining which patients needed emergency interventions (7,9,10).…”

Section: Introductionmentioning

confidence: 99%

“…In the setting of trauma, free intraabdominal or intrathoracic fluid indicates hemorhage (1,7,8). When compared to physical exam and CT imaging, bedside ultrasound is performed rapidly and assess accurate result in determining which patients needed emergency interventions (7,9,10). The aim of this study was to determine the usefulness of the FAST examination in first evaluation and observation of blunt trauma patients.…”

Section: Introductionmentioning

confidence: 99%

Use of Focused Assessment with Sonography in Trauma in Emergency Department Patients for Triage, Diagnosis and Disposition: A Series of Cases

Gülalp¹,

Karagün²,

Bellı³

et al. 2011

JAEM

View full text Add to dashboard Cite

Ultrasound Based Key Clinical Pathway Reduces the use of Hospital Resources for the Evaluation of Blunt Abdominal Trauma

Abstract: An ultrasound based KCP resulted in significant reductions in the use of invasive DPL and costly CT scanning in the evaluation of blunt abdominal trauma without risk to the patient.

Cited by 137 publications

References 16 publications

Ultrasound in abdominal trauma

Ultrasound in abdominal trauma

Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Use of Focused Assessment with Sonography in Trauma in Emergency Department Patients for Triage, Diagnosis and Disposition: A Series of Cases

Contact Info

Product

Resources

About