Hamada Sophie Rym, Delhaye Nathalie, Kerever Sebastien, Harrois Anatole, Duranteau Jacques
Anesthesiology and Critical Care Department, Service de Réanimation chirurgicale, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
Anesthesiology and Critical Care Department, AP-HP, Hôpital Pitié-Salpêtrière, Hôpitaux Universitaires Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Ann Intensive Care. 2016 Dec;6(1):62. doi: 10.1186/s13613-016-0166-0. Epub 2016 Jul 11.
The initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real "added value" of chest X-rays (CXRs) and pelvic X-rays (PXR), particularly in haemodynamically stable trauma patients. The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients.
This was a prospective, interventional, single-centre study including all primary blunt trauma patients admitted to the trauma bay with a suspicion of severe trauma. All patients underwent physical examination and eFAST (assessing abdomen, pelvis, pericardium and pleura) before a whole-body CT scan (WBCT). Patients fulfilling all stability criteria at any time in transit from the scene of the accident to the hospital were managed in the trauma bay without chest and PXR.
Amongst 430 patients, 148 fulfilled the stability criteria (stability criteria group) of which 122 (82 %) had no X-rays in the trauma bay. No diagnostic failure with an immediate clinical impact was identified in the stability criteria group (SC group). All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group. The time spent in the trauma bay was significantly shorter for the SC group without X-rays compared to those who received any X-ray (25 [20; 35] vs. 38 [30; 60] min, respectively; p < 0.0001). An analysis of the cost and radiation exposure showed savings of 7000 Є and 100 mSv, respectively.
No unrecognized diagnostic with a clinical impact due to the lack of CXR and PXR during the initial management of stable trauma patients was observed. The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan. It allowed a sensible cost and radiation saving.
创伤患者的初始处理是一个关键且要求颇高的阶段。创伤扩展 focused 评估超声（eFAST）在创伤病房的应用愈发普遍，这引发了关于胸部 X 光（CXR）和骨盆 X 光（PXR）实际“附加价值”的疑问，尤其是在血流动力学稳定的创伤患者中。本研究的目的是评估在稳定创伤患者中整合 eFAST 并排除 X 光检查的管理方案的有效性。
这是一项前瞻性、干预性、单中心研究，纳入所有因疑似严重创伤而入住创伤病房的原发性钝性创伤患者。所有患者在进行全身 CT 扫描（WBCT）前均接受体格检查和 eFAST（评估腹部、骨盆、心包和胸膜）。在从事故现场转运至医院的任何时间满足所有稳定性标准的患者，在创伤病房接受管理，不进行胸部和 PXR 检查。
在 430 例患者中，148 例符合稳定性标准（稳定性标准组），其中 122 例（82%）在创伤病房未进行 X 光检查。在稳定性标准组（SC 组）中未发现有直接临床影响的诊断失败情况。SC 组中所有需要胸腔闭式引流的气胸病例在 WBCT 扫描前均通过 eFAST 联合临床检查得以确诊。与接受任何 X 光检查的患者相比，SC 组未进行 X 光检查的患者在创伤病房花费的时间明显更短（分别为 25 [20; 35] 分钟和 38 [30; 60] 分钟；p < 0.0001）。成本和辐射暴露分析显示分别节省了 7000 欧元和 100 毫希沃特。
在稳定创伤患者的初始处理过程中，未观察到因缺乏 CXR 和 PXR 而导致有临床影响的未被识别的诊断情况。eFAST 联合体格检查提供了安全完成 WBCT 扫描所需的信息。它实现了合理的成本节省和辐射剂量降低。
Zotero 插件