On the Shoulders of Giants
Point of care limited ultrasound for trauma, aka FAST exam, reduced time to the operating room and several other important secondary outcomes.
Why does this matter?
The longer the time to definitive care for patients with operative traumatic injuries, the greater the risk. So if ultrasound could help with surgical decision making, this could reduce time to operation and possibly mortality. This RCT studied the effect of POCUS on these trauma patients.
All POCUS, No HOCUS
This was a RCT of FAST in patients with torso trauma at two level 1 trauma centers, with about 130 patients per group. The groups were well matched after randomization. With intention to treat analysis, they found that the FAST group had a decreased median time to the operating room: 60 minutes vs. 157 minutes. CT use was also decreased in the FAST group, and it also saved those patients a little money. Of course, this couldn’t be blinded. Also, the primary outcome seems important, but is not truly patient-centered. Did FAST reduce mortality or important metrics of morbidity? We don’t know from this study. But it does suggest that FAST may be helpful for trauma surgeons in making the decision to go to the OR.
Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006 Sep;48(3):227-35. Epub 2006 Mar 24.