The Role of Prehospital eFAST in Accelerating Time to Diagnostics or Definitive Treatment in the Emergency Department

Actual literature has demonstrated that prehospital extended focused assessment sonography for trauma (eFAST) could impact on logistic and treatment decisions such as mode of transportation and choice of hospital destination.

However, there are no data with regard to in-hospital effects of a positive prehospital eFAST.

The main objective of this study was to evaluate the effects of prehospital eFAST driven decisions on in hospital time-to-definitive diagnostics or time-to definitive treatment, whichever came first, in a level 1 trauma center.

The goal is to define if this information could have a role in prioritizing patients' access to care in a population of abdominal trauma patients with A-AIS > 1 and a documented liver or spleen injury.

Study Overview

• Status: Completed
• Conditions: Trauma Abdomen; Liver Injury; Trauma Splenic
• Intervention / Treatment: Diagnostic test: prehospital extended focused assessment sonography for trauma

• Study Type: Observational
• Enrollment (Actual): 199

Contacts and Locations

Study Locations

• Italy
  • Bologna, Italy, 40110
    • Maggiore Hospital Ospedale Maggiore Carlo Alberto Pizzardi AUSL di Bologna

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

This study will involve all the patients admitted to the Maggiore Hospital's emergency department (ED) from January 2014 to December 2019 with a traumatic liver or spleen injury who survived enough time to get a CT scan or a surgical intervention within 3 hours from the ED admission

Description

Inclusion Criteria:

• Patients admitted to emergency department with a ICD-9-CM diagnosis of traumatic liver or spleen injury (codes 8640x, 8641x, 8650x, 8651x)
• Abdominal AIS ≥ 2
• CT scan or operating theatre admission performed within 180 minutes from ED admission

Exclusion Criteria:

• Death before CT scan or OR/Angio suite admission (missing primary outcome measure)
• Transferred to other hospitals before CT scan or operating room admission
• Missing data

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Positive prehospital eFAST; Patients with a positive prehospital eFAST, independently from their hemodynamic status or other vital signs	Diagnostic test: prehospital extended focused assessment sonography for trauma; Sonographic procedure performed in the prehospital environment aiming at evaluating peritoneal free fluid in trauma patients; Other Names: eFAST
Negative or not performed prehospital eFAST; Patients with a positive prehospital eFAST, independently from their hemodynamic status or other vital signs	Diagnostic test: prehospital extended focused assessment sonography for trauma; Sonographic procedure performed in the prehospital environment aiming at evaluating peritoneal free fluid in trauma patients; Other Names: eFAST

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to definitive diagnostics or treatment	Time from the ED arrival to CT scan imaging or surgical intervention (whichever came first)	180 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prehospital time	Time from EMS dispatch to ED arrival	240 minutes
Sensitivity and specificity of prehospital eFAST	Sensitivity and specificity of prehospital eFAST calculated considering ED eFAST as the gold standard measure	240 minutes

Collaborators and Investigators

• Sponsor: Azienda Usl di Bologna

Publications and helpful links

General Publications

• Botker MT, Jacobsen L, Rudolph SS, Knudsen L. The role of point of care ultrasound in prehospital critical care: a systematic review. Scand J Trauma Resusc Emerg Med. 2018 Jun 26;26(1):51. doi: 10.1186/s13049-018-0518-x.
• Chang R, Kerby JD, Kalkwarf KJ, Van Belle G, Fox EE, Cotton BA, Cohen MJ, Schreiber MA, Brasel K, Bulger EM, Inaba K, Rizoli S, Podbielski JM, Wade CE, Holcomb JB; PROPPR Study Group. Earlier time to hemostasis is associated with decreased mortality and rate of complications: Results from the Pragmatic Randomized Optimal Platelet and Plasma Ratio trial. J Trauma Acute Care Surg. 2019 Aug;87(2):342-349. doi: 10.1097/TA.0000000000002263.
• Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma. 2002 Mar;52(3):420-5. doi: 10.1097/00005373-200203000-00002.
• El Zahran T, El Sayed MJ. Prehospital Ultrasound in Trauma: A Review of Current and Potential Future Clinical Applications. J Emerg Trauma Shock. 2018 Jan-Mar;11(1):4-9. doi: 10.4103/JETS.JETS_117_17.
• Jorgensen H, Jensen CH, Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur J Emerg Med. 2010 Oct;17(5):249-53. doi: 10.1097/MEJ.0b013e328336adce.

Study record dates

Study Major Dates

• Study Start (Actual): June 25, 2021
• Primary Completion (Actual): July 15, 2021
• Study Completion (Actual): July 26, 2021

Study Registration Dates

• First Submitted: June 14, 2021
• First Submitted That Met QC Criteria: June 21, 2021
• First Posted (Actual): June 22, 2021

Study Record Updates

• Last Update Posted (Actual): August 4, 2021
• Last Update Submitted That Met QC Criteria: July 29, 2021
• Last Verified: July 1, 2021

More Information

Terms related to this study

• Keywords: trauma; liver; spleen
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies; Wounds and Injuries
• Other Study ID Numbers: PreH-eFAST

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No