PROSPECTIVE EVALUATION OF SURGEONS' USE OF ULTRASOUND IN THE EVALUATION OF TRAUMA PATIENTS

TLDR

Ultrasound is a valuable diagnostic tool for trauma evaluation in Europe and Japan, yet in the United States its use is limited by availability, cost, and technician shortages. This prospective study aimed to determine whether trained trauma surgeons could use ultrasound to identify fluid in thoracoabdominal injuries. Four attending surgeons, four fellows, and 25 residents at a level‑I trauma center were trained in specific ultrasound techniques and then applied them to evaluate trauma patients. Among 476 patients, ultrasound detected 71 of 90 clinically significant injuries (79 % sensitivity) with 95.6 % specificity, demonstrating that surgeons can rapidly and accurately perform and interpret ultrasound, making it a rapid, sensitive, and specific modality for detecting intraabdominal fluid and pericardial effusion.

Abstract

Ultrasound diagnostic imaging has been demonstrated to be a valuable investigative tool in the evaluation of trauma patients in Europe and Japan. In the United States, however, ultrasound has not been widely used by trauma surgeons because of its lack of availability in the trauma resuscitation area and the associated cost and lack of full-time availability of a technician. In this prospective study, four attending trauma surgeons, four trauma fellows (PGY 6 and 7), and 25 surgical residents (PGY 4) at a level I trauma center were trained in specific ultrasound techniques to identify fluid in trauma patients with thoracoabdominal injuries. Their ultrasound evaluations of 476 patients demonstrated that in 90 patients with clinically significant injuries, ultrasound imaging successfully detected injury in 71, for a 79% sensitivity. Specificity was 95.6%. We conclude that (1) surgeons can rapidly and accurately perform and interpret ultrasound examinations; and (2) ultrasound is a rapid, sensitive, specific diagnostic modality for detecting intraabdominal fluid and pericardial effusion.