Early FAST Examinations during Resuscitation May Compromise Trauma Outcomes

Am Surg. 2018 Oct 1;84(10):1705-1709.

Abstract

Focused assessment with Sonography for trauma (FAST) examination is essential to trauma triage. We sought to determine whether FASTs completed early in sequencing portend worse outcomes. A two-year review (2014-2015) of all trauma activations at our Level I trauma center was performed. Patients were matched at baseline and FAST times were compared. Outcomes included resuscitation time (RESUS-h), ventilation days (d), hospital length of stay (HLOS-d), ICU length of stay (LOS-d), survival (%), nosocomial infection rate (%), and venous thromboembolism complication rate (%). ED interventions included transfusions, crystalloid, antibiotics, central line placement, intubation, thoracostomy, thoracotomy, pelvic X-ray, and binder. One thousand, three hundred and twelve patients were included for analysis (mean age = 38 ± 19 years, mean Injury Severity Score = 12 ± 11, 21% penetrating). Compared with FASTs completed after the primary survey, early FASTs led to significantly more ventilation days (P < 0.01), longer ICU length of stay (P < 0.01), and a greater incidence of nosocomial infections (P = 0.03). In the ED, early FASTs led to significantly more intubations (P < 0.01) and transfusions (P < 0.01) compared with late FASTs. FASTs completed before primary survey portend worse outcomes, with more ED interventions and equivocal results. FAST as a true adjunct to primary survey is recommended.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Blood Transfusion / statistics & numerical data
  • Cross Infection / etiology
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Focused Assessment with Sonography for Trauma / methods*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Respiration, Artificial / statistics & numerical data
  • Resuscitation / methods*
  • Retrospective Studies
  • Time Factors
  • Trauma Centers
  • Treatment Outcome
  • Wounds, Nonpenetrating / therapy
  • Wounds, Penetrating / therapy