Written by Chris Thom
Spoon Feed
In this multi-site study, the authors found a high prevalence of “ghost scans” during trauma alert activations, with significant variations between institutions.
Let’s prioritize saving the FAST exam during trauma alerts
This was a retrospective study of trauma alert activations among four urban level-1 trauma centers. Medical records were reviewed to determine if an eFAST examination was performed, and the imaging archiving system was then investigated to determine if imaging was saved. The nursing flowsheets were used as the “gold standard” to adjudicate if there was an eFAST exam performed during the trauma. A “ghost scan” was defined as an eFAST exam that occurred, with no associated imaging having been saved.
The four sites had a total of 6,145 trauma activations over the studied time period. The overall ghost scanning rate was 49.8%, with a low of 21.4% at one site and a high of 93.2% at another site. One site used only the EHR and PACS for POCUS documentation, while the other three used Qpath as a POCUS manager (middleware). All four sites used an order-based workflow. The site without a POCUS manager had a ghost scan rate of 65.5%.
How will this change my practice?
This study highlights a constant struggle in POCUS practice—namely, the ability to effectively save and document our POCUS studies. This is perhaps particularly challenging in trauma alert activations, where there are multiple cross-specialty players involved in the POCUS ordering, image acquisition, image archiving, and image documentation. Two key variables are likely involved in the disparate rates of ghost exams amongst these four sites. The first is ease of workflow for the physicians involved. Each click needed to save and document the FAST exam reduces compliance and impedes success. The second is culture. It is imperative for POCUS and trauma leaders to reinforce the importance of accurately documenting medical imaging in the patient record.
POCUS pro-tips
I’m hopeful that POCUS managers and US manufacturers will help us here. Auto-saving the best image is a feature becoming available, as is voice command for saving images. Comparing these results with similar Level 1 centers that use encounter-based POCUS workflow would also be interesting, as there is significant potential advantage in being able to identify the patient and start scanning prior to any EHR order being placed.
Source
Prevalence of ghost scans in point-of-care ultrasound for trauma patients: A multicenter study. Am J Emerg Med. 2026 Jan;99:354-358. doi: 10.1016/j.ajem.2025.10.043. Epub 2025 Oct 24. PMID: 41167009.
