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Prehospital FAST reduces time to admission and operative treatment: a prospective, randomized, multicenter trial

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Název: Prehospital FAST reduces time to admission and operative treatment: a prospective, randomized, multicenter trial
Autoři: Felix Walcher, Ingo Marzi, Ronny Otto, F. Brenner, M. Stier, Dorothea Hempel, Raoul Breitkreutz, Benjamin Lucas
Zdroj: Eur J Trauma Emerg Surg
Informace o vydavateli: Springer Science and Business Media LLC, 2021.
Rok vydání: 2021
Témata: Emergency Medical Services, 03 medical and health sciences, 0302 clinical medicine, Original Article, Abdominal injury, FAST, Ultrasonography/methods [MeSH], Prehospital ultrasound, Humans [MeSH], Prospective Studies [MeSH], Ambulances [MeSH], Trauma room, Abdominal Injuries [MeSH], Emergency Medical Services/methods [MeSH], Time-to-surgery, Ambulances, Humans, Abdominal Injuries, Prospective Studies, Ultrasonography, 3. Good health
Popis: BackgroundThe focused assessment with sonography in trauma (FAST) exam is an established trauma care diagnostic procedure. Ultrasound performed during prehospital care can improve early treatment and management of the patients. In this prospective randomized clinical trial, we wanted to assess whether a pre-hospital FAST (p-FAST) influences pre-hospital strategy and the time to operative treatment.MethodsWe studied 296 trauma victims in a prehospital setting. Inclusion criteria were potential abdominal injuries identified either by clinical examination or suggested by the mechanism of injury. Physician-staffed helicopters and emergency ambulances were equipped with portable ultrasound devices. According to a scheme related to calendar weeks, a clinical exam only (CEX) or a clinical exam together with a p-FAST (CEX-p-FAST) was conducted. Outcome variables were prehospital diagnosis and strategy, the time to admission to the trauma room and to operation theater. The study was approved by the university ethical committee (REB#: 46/06).ResultsCEX-p-FAST showed a high sensitivity (94.7%) and specificity (97.6%) in detection of free fluid compared to CEX-only (80.0%, 84.4%). The median time to admission was reduced significantly by 13 min and to operative treatment by 15 min after CEX-p-FAST. We observed a cross-over rate of 30.8% of p-FAST (n = 36) to CEX-p-FAST during the CEX-only weeks.ConclusionAccording to the experience of the principal investigators, CEX-p-FAST was superior to CEX-only. Despite the time needed for p-FAST, the relevant admission time was significantly shorter. Thus, p-FAST is recommended in addition to CEX if possible for decision-making in prehospital trauma care.Trial registrationGerman Clinical Trials Register #DRKS00022117—Registered 10 July 2020—Retrospectively registered,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022117.
Druh dokumentu: Article
Other literature type
Jazyk: English
ISSN: 1863-9941
1863-9933
DOI: 10.1007/s00068-021-01806-w
Přístupová URL adresa: https://link.springer.com/content/pdf/10.1007/s00068-021-01806-w.pdf
https://pubmed.ncbi.nlm.nih.gov/34661691
https://link.springer.com/article/10.1007/s00068-021-01806-w
https://link.springer.com/content/pdf/10.1007/s00068-021-01806-w.pdf
https://repository.publisso.de/resource/frl:6448449
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) .
Přístupové číslo: edsair.doi.dedup.....ae283c9018adffb1ed8ea946388a86dd
Databáze: OpenAIRE
Popis
Abstrakt:BackgroundThe focused assessment with sonography in trauma (FAST) exam is an established trauma care diagnostic procedure. Ultrasound performed during prehospital care can improve early treatment and management of the patients. In this prospective randomized clinical trial, we wanted to assess whether a pre-hospital FAST (p-FAST) influences pre-hospital strategy and the time to operative treatment.MethodsWe studied 296 trauma victims in a prehospital setting. Inclusion criteria were potential abdominal injuries identified either by clinical examination or suggested by the mechanism of injury. Physician-staffed helicopters and emergency ambulances were equipped with portable ultrasound devices. According to a scheme related to calendar weeks, a clinical exam only (CEX) or a clinical exam together with a p-FAST (CEX-p-FAST) was conducted. Outcome variables were prehospital diagnosis and strategy, the time to admission to the trauma room and to operation theater. The study was approved by the university ethical committee (REB#: 46/06).ResultsCEX-p-FAST showed a high sensitivity (94.7%) and specificity (97.6%) in detection of free fluid compared to CEX-only (80.0%, 84.4%). The median time to admission was reduced significantly by 13 min and to operative treatment by 15 min after CEX-p-FAST. We observed a cross-over rate of 30.8% of p-FAST (n = 36) to CEX-p-FAST during the CEX-only weeks.ConclusionAccording to the experience of the principal investigators, CEX-p-FAST was superior to CEX-only. Despite the time needed for p-FAST, the relevant admission time was significantly shorter. Thus, p-FAST is recommended in addition to CEX if possible for decision-making in prehospital trauma care.Trial registrationGerman Clinical Trials Register #DRKS00022117—Registered 10 July 2020—Retrospectively registered,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022117.
ISSN:18639941
18639933
DOI:10.1007/s00068-021-01806-w