Written by Ketan Patel
An initial diagnostic workup that includes an E-FAST exam and targeted chest and pelvis x-rays allows clinicians an opportunity to assess and intervene appropriately on the majority of patients prior to WBCT in the setting of blunt trauma.
Why does this matter?
Few studies have assessed the diagnostic value of a E-FAST exam prior to the gold standard WBCT in blunt trauma patients. This study quantifies that value to validate a diagnostic approach that utilizes targeted plain x-ray, E-FAST exams, and WBCT in the paradigm of care of these patients.
Straight to the donut of truth? Not so FAST.
This study was a prospective cohort of blunt trauma patients presenting to 6 French trauma centers. A workup that included targeted radiographs, E-FAST and eventual WBCT were utilized in the management of these patients. The care of these patients was then evaluated for appropriateness by an expert panel who reviewed the cases.
In this cohort, care was deemed appropriate in 96.7% of cases (493 total). It is important to note that the E-FAST exam that they utilized included a transcranial Doppler exam to assess cerebral blood flow. In most patients, the E-FAST and targeted radiographs provided clinicians with information to allow them to abstain from any therapeutic interventions and safely perform the WBCT (233 patients).
On the other patients, the initial imaging provided crucial information to dictate immediate interventions and stabilization prior to WBCT. Of the deemed inappropriate cases (17), 13 were the result of deviation from guidelines, and 4 were due to errors in interpreting the E-FAST exam.
While there are several limitations to this study due mode of assessment of appropriateness and inability to blind, it does support the current practice of utilizing all 3 imaging modalities in blunt trauma. The utility of E-FAST and radiographs especially support decision-making in unstable patients before WBCT.
Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open. 2022 Dec 1;5(12):e2245432. doi: 10.1001/jamanetworkopen.2022.45432.