Zieleskiewicz L, et al. - In this retrospective single center study, the researchers assessed the diagnostic accuracy and therapeutic impact of an initial imaging work-up including a chest x-ray, pelvic x-ray, and extended focused assessment with sonography for trauma (eFAST) in severe trauma patients as well as assessed the therapeutic impact of a chest x-ray according to the lung ultrasonography findings. A high rate of appropriate decisions was found after the initial imaging work-up, including a pelvic x-ray, chest x-ray, and eFAST. Data reported that the pelvic x-ray had a minimal therapeutic impact. In the patients with normal lung ultrasounds, the chest x-ray marginally affected the management of the patients.

Methods

• For this investigation, patients with severe trauma who were admitted directly to the level 1 trauma center were consecutively involved.
• According to the initial assessment results of the whole body computed tomography scan and surgery reports, the diagnostic accuracy, therapeutic impact, and appropriate decision rate were calculated.

Results

• Out of 1315 trauma patients admitted, 756 were enrolled in this investigation.
• As compared to the chest x-ray, lung ultrasound demonstrated a higher diagnostic accuracy for haemothorax and pneumothorax cases.
• It was observed that sensitivity and specificity of the abdominal ultrasound to identify intraperitoneal effusion were 70% and 96%, respectively.
• Findings revealed that the initial assessment had a therapeutic impact in 76 (10%) of the patients, involving 16 (2%) immediate laparotomies and 58 (7%) chest tube insertions.
• It was noted that the pelvic x-ray had no therapeutic impact, and when the lung ultrasound was normal, the chest x-ray had a therapeutic impact of only 0.13%.
• Data reported that combining the chest x-ray and lung ultrasound allowed adequate management of all the pneumothorax and haemothorax cases.
• According to the findings obtained, only one of the 756 subjects had initial management that was judged as inappropriate and this patient had a missed pelvic disjunction with active retroperitoneal bleeding, and had an inappropriate immediate laparotomy.