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Initial focused assessment with sonography in trauma versus initial CT for patients with haemodynamically stable torso trauma
  1. Yutaka Kondo1,2,
  2. Hiroyuki Ohbe1,
  3. Hideo Yasunaga1,
  4. Hiroshi Tanaka2
  1. 1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
  2. 2Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
  1. Correspondence to Yutaka Kondo, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 1130033, Japan; kondokondou2000{at}yahoo.co.jp

Abstract

Objective Focused assessment with sonography in trauma (FAST) examination is a widely known initial evaluation for patients with trauma. However, it remains unclear whether FAST contributes to patient survival in patients with haemodynamically stable trauma. In this study, we compared in-hospital mortality and length of stay between patients undergoing initial FAST vs initial CT for haemodynamically stable torso trauma.

Methods This was a retrospective cohort study using data from 264 major emergency hospitals in the Japan Trauma Data Bank between 2004 and 2016. Patients were included if they had torso trauma with a chest or abdomen abbreviated injury scale score of ≥3 and systolic blood pressure of ≥100 mm Hg at hospital arrival. Eligible patients were divided into those who underwent initial FAST and those who underwent initial CT. Multivariable logistic regression analysis for in-hospital mortality and multivariable linear regression for length of stay were performed to compare the initial FAST and initial CT groups with adjustment for patient backgrounds while also adjusting for within-hospital clustering using a generalised estimating equation.

Results There were 9942 patients; 8558 underwent initial FAST and 1384 underwent initial CT. Multivariable logistic regression showed no significant difference in in-hospital mortality between the initial FAST and initial CT groups (OR 1.37, 95% CI 0.94 to 1.99, p=0.10). Multivariable linear regression revealed that the initial FAST group had a significantly longer length of stay than the initial CT group (difference: 3.5 days; 95% CI 1.0 to 5.9, p<0.01).

Conclusions In-hospital mortality was not significantly different between the initial FAST and initial CT groups for patients with haemodynamically stable torso trauma. Initial CT should be considered in patients with haemodynamically stable torso trauma.

  • trauma
  • ultrasonography
  • tomography
  • emergency departments
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Footnotes

  • Contributors YK conceived this study, analysed the data and drafted the manuscript. HO partially analysed the data and revised the manuscript. HY and HT advised on the design and revised the manuscript. All authors checked and agreed on the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The protocol of the present study was approved (number 29-061) by the ethics committee of the Juntendo University Urayasu Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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