Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: Impact on the management of 756 patients

Zieleskiewicz, Laurent; Fresco, Raphaelle; Duclos, Gary; Antonini, François; Mathieu, Calypso; Medam, Sophie; Vigne, Coralie; Poirier, Marion; Roche, Pièrre-Hugues; Bouzat, Pierre; Kerbaul, François; Scemama, Ugo; Bège, Thierry; Thomas, Philippe; Flécher, Xavier; Hammad, Emmanuelle; Léone, Marc

doi:10.1016/j.injury.2018.07.002

Cited by 40 publications

(34 citation statements)

References 26 publications

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“…[3][4][5] Similar integrative ultrasound approaches have been advocated in human medicine. 18,[23][24][25][26] Additional limitations of our case series include the fact that enrolled were patients were limited to animals presented to an emergency service. Additional prospective studies are warranted to confirm the true prevalence of GBWE in patients with cardiac disease in a larger cohort of cardiac disease patients including those with PCE, right-sided congestive heart failure, and other diseases.…”

Section: Discussionmentioning

confidence: 99%

Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease

Lisciandro¹,

Gambino

Lisciandro³

2021

Veterinary Internal Medicne

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Background: Ultrasonographically detected gallbladder wall edema (GBWE) is a marker for anaphylaxis in dogs. Cardiac disease can cause GBWE with similar signs and should be included as a differential diagnosis to prevent interpretation errors.Hypothesis/Objectives: Document GBWE associated with cardiac disease.Animals: Fourteen client-owned animals.Methods: Prospective case series with abdominal focused assessment with abdominal sonography in trauma, triage and tracking (AFAST), and thoracic focused assessment with abdominal sonography in trauma, triage, and tracking (TFAST) performed at triage. Animals with GBWE and cardiac disease were enrolled. A board-certified radiologist reviewed images to confirm cardiac disease, GBWE, and characterize the caudal vena cava (CVC) and hepatic veins.Results: Thirteen dogs and 1 cat had GBWE associated with cardiac disease. Gallbladder findings included mural thickness ranging from 3 to 5 mm, mild to moderate sludge (n = 3), and mild to moderate luminal distension (n = 6). CVC and hepatic venous distension were found in 5/6. Cardiac diagnoses in dogs included 11 with pericardial effusion (PCE) and 1 each with dilated cardiomyopathy and right-sided myocardial failure. Severity of PCE was rated as mild (n = 1), moderate (n = 6), or severe (n = 4). Seven of 11 had pericardiocentesis performed. Nine of 13 had ascites with 4 having abdominal fluid scores of 1 (n = 2), 2 (n = 2), 3 (n = 1), and 4 (n = 0). Lung ultrasound findings were as follows: dry lung (n = 6), B-lines (n = 4), and nodules (n = 1). The cat had moderate PCE, ascites scored as 1, and severe rightsided ventricular enlargement associated with a ventricular septal defect. Primary presenting complaints included acute weakness (n = 9), acute collapse (n = 5), gastrointestinal signs (n = 3), respiratory distress (n = 2), and need for cardiopulmonary resuscitation (n = 1).

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Section: Discussionmentioning

confidence: 99%

Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease

Lisciandro¹,

Gambino

Lisciandro³

2021

Veterinary Internal Medicne

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“…without additional expenditure of time for the overall care. If this is not possible, eFAST should not delay CT 100% strong GoR A 100% strong Literature : detected = 699, excluded = 681, full-text: rated = 18, excluded = 6, included = 12 (guideline: [ 15 , 19 , 37 – 39 ]; level 1: [ 40 ]; level 2: [ 41 , 42 ]; level 3: [ 43 , 44 ]; level 4: [ 45 ]; level 5: [ 46 ]) Comments : eFAST ought to be a screening for diagnostic findings requiring immediate treatment. With this meaning eFAST is a filter to (maybe temporarily) exclude (very few) patients from CT-scanning because of reasons where the time effort of CT is expected to lead to higher mortality.…”

Section: Methodsmentioning

confidence: 99%

European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)

et al. 2020

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Background Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. Results Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org) and a short version also covering all recommendations (this article). Conclusions Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.

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“…FAST/eFAST выполняется в течение 1-2 мин, определяет признаки гемоперикарда с чувствительностью 90-95% [4] и превосходит рентгенографию в точности диагностики пневмоторакса и гемоторакса [5]. В связи с этим ультразвуковое исследование предлагается использовать в качестве первичного метода диагностики повреждений груди у нестабильных пациентов [7,8]. Специфичность FAST/eFAST в выявлении пневмоторакса, гемоторакса и свободной внутрибрюшной жидкости достигает 96-98,6%, но чувствительность метода невысока и составляет 37-84,5% [5,7].…”

Section: тактика целенаправленной лучевой диагностикиunclassified

“…В связи с этим ультразвуковое исследование предлагается использовать в качестве первичного метода диагностики повреждений груди у нестабильных пациентов [7,8]. Специфичность FAST/eFAST в выявлении пневмоторакса, гемоторакса и свободной внутрибрюшной жидкости достигает 96-98,6%, но чувствительность метода невысока и составляет 37-84,5% [5,7]. То есть FAST/eFAST позволяет быстро обнаружить клинически значимый пневмоторакс и гемоторакс, а также наличие жидкости в брюшной полости, но отрицательный результат исследования не является достаточным, чтобы их исключить.…”

Section: тактика целенаправленной лучевой диагностикиunclassified

“…Первичная рентгенография таза актуальна для пациентов с нестабильной гемодинамикой с целью исключения переломов тазовых костей, которые могут быть основным источником кровотечения. Ее рутинное выполнение у стабильных больных с отсутствием клинических признаков повреждений таза признано неоправданным [3,4,7]. МСКТ таза с контрастированием значимо превосходит по точности рентгенографию [8], позволяет выявить признаки внутритазового кровотечения и определить показания к ангиографической эмболизации [4].…”

Section: тактика целенаправленной лучевой диагностикиunclassified

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Tactics of Primary Emergency Radiation Diagnosis of Politrauma

Шапкин

Seliverstov

Стекольников

2021

Vestn. rentgenol. radiol.

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The review considers the problem of choosing the optimal tactical approach to primary emergency radiation diagnosis of injuries during polytrauma based on data on indications for use, advantages and disadvantages of modern methods and protocols of radiation imaging. Literary sources were searched in the MedLine/ PubMed and eLibrary databases published from 2009 to 2019.The tactics of selective radiation diagnosis of polytrauma involves performing sequential studies (sonography, X-ray, computed tomography) of body areas in which damage is suspected by the mechanism of injury and clinical data, which limits the accuracy of the diagnosis and increases the duration of the examination. Primary multi-helical “whole-body”computed tomography including head, neck, chest, abdomen and pelvis examination, reduces the percentage of missed injuries, the duration of the examination and the time before emergency surgery, which can significantly reduce mortality in polytrauma. Its use is justified in patients with severe combined trauma if a high level of emergency hospital care organization is provided. Using “whole-body” computed tomography significantly increases the dose and economic costs, but the benefits of it for the survival of patients with polytrauma can outweigh the radiation risk and economic losses. Further development of technologies and protocols for multispiral computed tomography can significantly reduce the dose of radiation and the duration of the study. Clear and well-founded criteria for the selection of patients are needed for whom the use of “whole-body” computed tomography will be an effective strategy for radiation diagnosis.

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Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: Impact on the management of 756 patients

Cited by 40 publications

References 26 publications

Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease

Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease

European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)

Tactics of Primary Emergency Radiation Diagnosis of Politrauma

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