A Prospective evaluation of “focused assessment withsonography for trauma” done by Emergency Nurses and its comparative analysis with radiologists performance in identifying fluid during initial resuscitation of trauma Bhoi S,SoniaChauhan, Geeta A,Shakuntla , Shoukkathali V,Sinha Tej P, RK. Ramchandani Deptt. of Emergency Medicine,J P N Apex Trauma Center,AIIMS firstname.lastname@example.org
Background Ultrasound has been used in the early assessment of abdominal trauma. Emergency Ultrasound (EUS) helps the treating clinician to identify emergent conditions thus facilitating the rapid diagnosis and treatment of critically ill patients Point of care sonography training to Emergency Nurses in India would facilitate multiple skill hands especially in mass casualty incidents.
Objective To determine the accuracy of emergency nurses in detecting free fluid in abdomen when compared to radiologist during primary survey of trauma victims by focused assessment with Sonography for trauma [FAST] scan in the Emergency Department [ED].
METHODOLOGY• Study design- Qualitative prospective study• Performance centre - ED of JPN Apex Trauma Centre, AIIMS.• Study duration-January to September 2011
The study subjects included emergency Nurses (EN) who underwent training at 3-day workshop on emergency sonography They performed 10 supervised positive and negative scans for free fluid. The FAST scans were first performed by the EN’s and then by radiology resident (RR). Both were blinded to each other’s sonography findings. CT scan and laparotomy findings were used as gold standard whichever was feasible. Results were compared between both groups.
FAST Focused Assessment by Sonography in Trauma AUTLS
FAST scan Minimal amount of fluid in abdomen detectable by USG ~ 200 - 650ml High sensitivity in detecting hemoperitoneum (63 -100% ) High specificity in detecting hemoperitoneum (96 - 99%)100%) Low sensitivity in detecting specific organ lesions (<50%)
FAST Exam- Primary Views orWindows1. Subxiphoid2. Right upper quadrant (RUQ)3. Left upper quadrant (LUQ)4. Suprapubic
Results 94 scans performed each by EN and RR were analysed. Mean age of the patients was 29 [2 - 85] years. Out of 23 true positive patients 18 underwent CT scan and exploratory laparotomy was done in 14 patients. Sensitivity of FAST done by EN and RR was 90 %. Specificity of FAST done by EN was 94.6 %Vs RR. Positive predictive value and negative predictive values were 81.8% and 97.2% respectively
Limitation: Inter-observer variability was not noted
FAST: Strengths and LimitationsStrengths Limitations Rapid (~2 mins) Does not typically identify Portable source of bleeding, or detect Inexpensive injuries that do not cause hemoperitoneum Technically simple, easy to Requires extensive training train (studies show to assess parenchyma competence can be achieved reliably after ~30 studies) Limited in detecting <250 cc Can be performed serially intraperitoneal fluid Useful for guiding triage Particularly poor at detecting decisions in trauma patients bowel and mesentery damage (44% sensitivity) Difficult to assess retroperitoneum Limited by habitus in obese patients
Conclusion FAST scan performed by EN who are trained in short course of ultrasonography can be reliable and accurate when comparable to qualified radiologist. It can be helpful during crisis scenarios e.g. Mass casualty incidents.