Ultrasound Evaluation of Blunt Abdominal Trauma

Thomas, Bruce; Falcone, Robert E.; Vasquez, Donald G.; Santanello, Steven A.; Townsend, Michael C.; Hockenberry, S.; Innes, J.; Wanamaker, Steven R.

doi:10.1097/00005373-199703000-00004

Cited by 149 publications

(18 citation statements)

References 16 publications

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“…Patients that received FAST had a 64% decrease in the time to operative intervention, and decreased complication rates and hospital length of stay [30]. The sensitivity of FAST scans in detecting intraperitoneal hemorrhage is 75-78% and its specificity is 98-100%, suggesting it is a useful tool to confirm the presence of hemoperitoneum and hemopericardium [31,32]. Clinically, the FAST scan is particularly beneficial in the hypotensive trauma patient whose source of hypotension is unclear [33].…”

Section: Introductionmentioning

confidence: 99%

Review article: Use of ultrasound in the developing world

et al. 2011

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As portability and durability improve, bedside, clinician-performed ultrasound is seeing increasing use in rural, underdeveloped parts of the world. Physicians, nurses and medical officers have demonstrated the ability to perform and interpret a large variety of ultrasound exams, and a growing body of literature supports the use of point-of-care ultrasound in developing nations. We review, by region, the existing literature in support of ultrasound use in the developing world and training guidelines currently in use, and highlight indications for emergency ultrasound in the developing world. We suggest future directions for bedside ultrasound use and research to improve diagnostic capacity and patient care in the most remote areas of the globe.

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Section: Introductionmentioning

confidence: 99%

Review article: Use of ultrasound in the developing world

et al. 2011

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“…The most commonly studied technique is the focused assessment with sonography in trauma (FAST) exam [10]. Estimates for the learning curve associated with this technique have been extremely variable, however, and range from 10 [16, 17] to 200 studies [18] and even up to 500 scans [19].…”

Section: Discussionmentioning

confidence: 99%

“…The heterogeneity in these results likely results from the fact that there is no clear, accepted definition of what is an acceptable performance. The majority of these studies utilized clinical endpoints (correct identification of free fluid) to define the learning curve with varying thresholds of acceptable results [10, 16–18, 20–23], while only a single study utilized an assessment of image quality and technique [24]. …”

Section: Discussionmentioning

confidence: 99%

“…Significant inter-rater variance early in the learning curve is a potential concern that could affect the utility of this approach in more novice users. The literature surrounding learning curves for point of care ultrasound in general is limited [10] and even more so for the specific technique of ONSD measurement [11]. Here we attempt to employ a unique statistical method for estimating the potential learning curve for ONSD measurement.…”

Section: Introductionmentioning

confidence: 99%

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A unique method for estimating the reliability learning curve of optic nerve sheath diameter ultrasound measurement

et al. 2016

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BackgroundOptic nerve sheath diameter (ONSD) measurement using ultrasound has been proposed as a rapid, non-invasive, point of care technique to estimate intra-cranial pressure (ICP). Ultrasonic measurement of the optic nerve sheath can be quite challenging and there is limited literature surrounding learning curves for this technique. We attempted to develop a method to estimate the reliability learning curve for ONSD measurement utilizing a unique definition of reliability: a plateau in within-subject variability with unchanged between-subject variability.MethodsAs part of a previously published study, a single operator measured the ONSD in 120 healthy volunteers over a 6-month period. Utilizing the assumption that the four measurements made on each subject during this study should be equal, the relationship of within-subject variance was described using a quadratic-plateau model as assessed by segmental polynomial (knot) regression.ResultsSegmental polynomial (knot) regression revealed a plateau in within-subject variance after the 21st subject. However, there was no difference in overall mean values [3.69 vs 3.68 mm (p = 0.884)] or between-subject variance [14.49 vs 11.92 (p = 0.54)] above or below this cutoff.ConclusionsThis study suggests a significant finite learning curve associated with ONSD measurements. It also offers a unique method of calculating the learning curve associated with ONSD measurement.

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“…They can be compared against trained radiologist as well as international results [Table 5]. [7810] The comparatively small number of patients with hemoperitoneum in the series may account for the high sensitivity in our study. The number of patients in the study, although small by international standards, is a representative sample size.…”

Section: Discussionmentioning

confidence: 99%

To determine the accuracy of focused assessment with sonography for trauma done by nonradiologists and its comparative analysis with radiologists in emergency department of a level 1 trauma center of India

Bhoi

Sinha

Ramchandani

et al. 2013

J Emerg Trauma Shock

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Background:Focused assessment with sonography for trauma (FAST) is an important skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in emergency care settings is lacking in India.Objective:To determine the accuracy of FAST done by nonradiologists (NR) when compared to radiologists during primary survey of trauma victims in the emergency department of a level 1 trauma center in India.Materials and Methods:A prospective study was done during primary survey of resuscitation of nonconsecutive patients in the resuscitation bay. The study subjects included NR such as one consultant emergency medicine, two medicine residents, one orthopedic resident and one surgery resident working as trauma team. These subjects underwent training at 3-day workshop on emergency sonography and performed 20 supervised positive and negative scans for free fluid. The FAST scans were first performed by NR and then by radiology residents (RR). The performers were blinded to each other's sonography findings. Computed tomography (CT) and laparotomy findings were used as gold standard whichever was feasible. Results were compared between both the groups. Intraobserver variability among NR and RR were noted.Results:Out of 150 scans 144 scans were analyzed. Mean age of the patients was 28 [1-70] years. Out of 24 true positive patients 18 underwent CT scan and exploratory laparotomies were done in six patients. Sensitivity of FAST done by NR and RR were 100% and 95.6% and specificity was 97.5% in both groups. Positive predictive value among NR and RR were 88.8%, 88.46% and negative predictive value were 97.5% and 99.15%. Intraobserver performance variation ranged from 87 to 97%.Conclusion:FAST performed by NRs is accurate during initial trauma resuscitation in the emergency department of a level 1 trauma center in India.

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Ultrasound Evaluation of Blunt Abdominal Trauma

Abstract: This experience with the de novo implementation of a trauma US program suggests that the training and credentialing requirements in this study are sufficient to provide surgeon ultrasonographers with acceptable competence in US diagnosis of blunt abdominal trauma.

Cited by 149 publications

References 16 publications

Review article: Use of ultrasound in the developing world

Review article: Use of ultrasound in the developing world

A unique method for estimating the reliability learning curve of optic nerve sheath diameter ultrasound measurement

To determine the accuracy of focused assessment with sonography for trauma done by nonradiologists and its comparative analysis with radiologists in emergency department of a level 1 trauma center of India

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