Initial focused assessment with sonography in trauma versus initial CT for patients with haemodynamically stable torso trauma

Abstract

ObjectiveFocused 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.MethodsThis 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.ResultsThere 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).ConclusionsIn-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.

Impact of Sex Differences on Mortality in Patients With Sepsis After Trauma: A Nationwide Cohort Study

“…The data were available at the Japan Trauma Data Bank (JTDB), which was established in 2003 by the Japanese Association for the Surgery of Trauma (Trauma Registry Committee) and the Japanese Association for Acute Medicine (Committee for Clinical Care Evaluation) as the main parties (13). The database contains nationwide data on patients with trauma and includes patient characteristics, vital signs during the prehospital phase and upon hospital arrival, examinations and treatment records, types and causes of trauma, diagnostic codes using the abbreviated injury scale score (14), several trauma severity scores, hospitalization length, and discharge status (15).…”