OBJECTIVE: There is a paucity of evidence demonstrating that emergency department (ED) ultrasound changes clinical practice in trauma patients. We hypothesized that the presence of ultrasound would affect clinical decision making as evidenced through abdominal computed tomographic (CT) scan use in blunt multiple trauma patients. METHODS: This study used a prospective randomized format in an urban county ED with Level II trauma center status (ED census, 72,000 patients per year). Participants were patients with multiple blunt injuries meeting trauma center triage criteria. Patients were randomized to receive either abdominal ultrasound or no ultrasound (control) during initial ED resuscitation. The primary outcome variable was use of abdominal CT scan in patients with and without ultrasound. RESULTS:Two hundred eight patients were enrolled. The mean age was 40 +/- 18 years, and 62% were men. Mechanism of injury was motor vehicle crash, 56%; automobile versus pedestrian, 18%; motorcycle crash, 16%; falls, 10%; and other, 10%. One hundred four ultrasound and 104 control patients were analyzed. There were no apparent differences between ultrasound and control groups in demographics, injury type, or Injury Severity Score. Fifty-four of 104 (52%) of the control group received abdominal CT scans versus 37 of 104 (36%) abdominal CT scans for the ultrasound group; mean difference in proportions was 15.9 (p < 0.01; 95% confidence interval, 2.6-29.1). CONCLUSION: In this trial, the routine use of abdominal ultrasound in the evaluation of patients with multiple blunt injuries resulted in significantly fewer abdominal CT scans being obtained. A larger trial is needed to more clearly define the clinical and financial impact of ultrasound in the management of blunt abdominal trauma.
RCT Entities:
OBJECTIVE: There is a paucity of evidence demonstrating that emergency department (ED) ultrasound changes clinical practice in traumapatients. We hypothesized that the presence of ultrasound would affect clinical decision making as evidenced through abdominal computed tomographic (CT) scan use in blunt multiple traumapatients. METHODS: This study used a prospective randomized format in an urban county ED with Level II trauma center status (ED census, 72,000 patients per year). Participants were patients with multiple blunt injuries meeting trauma center triage criteria. Patients were randomized to receive either abdominal ultrasound or no ultrasound (control) during initial ED resuscitation. The primary outcome variable was use of abdominal CT scan in patients with and without ultrasound. RESULTS: Two hundred eight patients were enrolled. The mean age was 40 +/- 18 years, and 62% were men. Mechanism of injury was motor vehicle crash, 56%; automobile versus pedestrian, 18%; motorcycle crash, 16%; falls, 10%; and other, 10%. One hundred four ultrasound and 104 control patients were analyzed. There were no apparent differences between ultrasound and control groups in demographics, injury type, or Injury Severity Score. Fifty-four of 104 (52%) of the control group received abdominal CT scans versus 37 of 104 (36%) abdominal CT scans for the ultrasound group; mean difference in proportions was 15.9 (p < 0.01; 95% confidence interval, 2.6-29.1). CONCLUSION: In this trial, the routine use of abdominal ultrasound in the evaluation of patients with multiple blunt injuries resulted in significantly fewer abdominal CT scans being obtained. A larger trial is needed to more clearly define the clinical and financial impact of ultrasound in the management of blunt abdominal trauma.
Authors: Jennifer R Marin; Alyssa M Abo; Alexander C Arroyo; Stephanie J Doniger; Jason W Fischer; Rachel Rempell; Brandi Gary; James F Holmes; David O Kessler; Samuel H F Lam; Marla C Levine; Jason A Levy; Alice Murray; Lorraine Ng; Vicki E Noble; Daniela Ramirez-Schrempp; David C Riley; Turandot Saul; Vaishali Shah; Adam B Sivitz; Ee Tein Tay; David Teng; Lindsey Chaudoin; James W Tsung; Rebecca L Vieira; Yaffa M Vitberg; Resa E Lewiss Journal: Crit Ultrasound J Date: 2016-11-03
Authors: James F Holmes; Kenneth M Kelley; Sandra L Wootton-Gorges; Garth H Utter; Lisa P Abramson; John S Rose; Daniel J Tancredi; Nathan Kuppermann Journal: JAMA Date: 2017-06-13 Impact factor: 56.272
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Philip F Stahel; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2010-04-06 Impact factor: 9.097