Weile Jesper, Nielsen Klaus, Primdahl Stine C, Frederiksen Christian A, Laursen Christian B, Sloth Erik, Kirkegaard Hans
Emergency Department, Regional Hospital Herning, Herning, Denmark.
Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 1B, 8000, Aarhus C, Denmark.
Crit Ultrasound J. 2017 Dec;9(1):16. doi: 10.1186/s13089-017-0071-2. Epub 2017 Jun 20.
The Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark.
We conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation of existing guidelines, and the second phase was a series of structured interviews of orthopedic surgeons, anesthesiologists, and radiologists on call in all hospitals receiving traumatized patients in Denmark.
Guidelines were obtained from all 22 hospitals receiving traumatized patients in Denmark. Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST indications varied between circulatory instability n = 8 (36.4%), team leader's discretion n = 6 (27.3%), abdominal trauma n = 3 (13.6%), and not specified n = 6 (27.3%). Telephone interviews revealed that exams were always n = 8 (36.4%) or often n = 4 (18.2%) registered in the patients' charts. The remaining n = 10 (45.5%) facilities either never registered n = 2 (9.1%), it was not possible to register n = 1 (4.5%), or unknown by the trauma leaders n = 7 (31.8%). Images were often stored in n = 1 (4.5%), never stored in n = 10 (45.5%), not possible to store in n = 2 (9.1%), and unknown in n = 9 (40.9%) facilities.
Ultrasonography was used in a non-uniform fashion by multiple specialties in Danish trauma facilities. Very few images from FAST examinations were stored and documentation was scanty. National guidelines on application and documentation of ultrasonography in trauma are called for.
创伤超声重点评估（FAST）方案被认为有助于对钝性或穿透性损伤的创伤患者进行紧急评估，并已纳入高级创伤生命支持（ATLS）方案。丹麦尚无关于创伤超声检查使用的指南。我们旨在确定丹麦目前使用超声检查评估创伤患者的情况。
我们对创伤护理中超声检查的使用进行了一项全国性横断面调查。第一阶段包括对现有指南进行基于互联网的调查，第二阶段是对丹麦所有接收创伤患者的医院中值班的骨科医生、麻醉医生和放射科医生进行一系列结构化访谈。
从丹麦所有22家接收创伤患者的医院获取了指南。其中21份（95.5%）指南纳入并推荐FAST作为创伤评估的一部分。建议进行检查的人员为放射科医生的有n = 11家（50.0%），外科医生的有n = 6家（27.3%），麻醉医生的有n = 1家（4.5%），3家（13.6%）机构未明确指定。FAST的适应证在循环不稳定方面有n = 8例（36.4%），团队负责人酌情决定的有n = 6例（27.3%），腹部创伤的有n = 3例（13.6%），未明确说明的有n = 6例（27.3%）。电话访谈显示，检查记录在患者病历中的情况为总是有n = 8例（36.4%）或经常有n = 4例（18.2%）。其余n = 10家（45.5%）机构中，要么从未记录有n = 2家（9.1%），无法记录有n = 1家（4.5%），要么创伤负责人不清楚有n = 7家（31.8%）。图像经常存储的有n = 1家（4.5%），从未存储的有n = 10家（45.5%），无法存储的有n = 2家（9.1%），9家（40.9%）机构情况不明。
丹麦创伤机构中多个专业对超声检查的使用方式不一致。FAST检查的图像很少被存储，记录也很少。需要制定关于创伤超声检查应用和记录的国家指南。
