Journal of Trauma and Injury

Original Articles

The Effectiveness of Extended Focused Assessment with Sonography for Trauma Education Conducted on the Medical College Students: Kyu Ho Oh, Han Ho Do, Hee Young Kim, Jun Seok Seo; J Trauma Inj. 2016;29(3):82-88. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.82

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PURPOSE
Sonongraphic examinations such as extended Focused Assessment with Sonography in Trauma (eFAST) are widely used in Emergency Departments. This study is designed to determine student achievement by teaching medical college students through short training.
METHODS
38 participants in their 3rd year of medical school were enrolled in this study. An Emergency Medicine physician trained the students to 2 hours of theoretical training followed by 2 hours of hands on training.
RESULTS
The average age of students was 28.1±3.4, with 21 male students. The average of pre-educational test results were 60.4±8.9 and post-educational exam results were 80.1±14.5 (p<0.001). The average success rate of eFAST was 87.5%. But success rate of each items were lowest in checking the hepatorenal recess and the splenorenal recess, each success rate, 65.8% and 68.4%, consecutively. The questionnaires filled out after the study showed that the students were highly interested in this education and that they found the education easy to understand. They also answered that eFAST education is necessary in the medical college curriculum.
CONCLUSION
This study shows that eFAST can be effectively taught to students through short training.

Summary

Citations

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Diagnostic performance of the extended focused assessment with sonography for trauma (EFAST) patients in a tertiary care hospital of Nepal
Samjhana Basnet, Sanu Krishna Shrestha, Alok Pradhan, Roshana Shrestha, Anmol Purna Shrestha, Grishma Sharma, Sahil Bade, Latika Giri
Trauma Surgery & Acute Care Open.2020; 5(1): e000438. CrossRef

FAST Reappraisal: Cross-sectional Study: Sang Hyun Ha, Chong Kun Hong, Jun Ho Lee, Seong Youn Hwang, Seong Hee Choi; J Korean Soc Traumatol. 2012;25(3):67-71.

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Abstract PDF: PURPOSE
Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard.
METHODS
The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department.
RESULTS
There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively.
CONCLUSION
Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients.; Summary

Comparison of Compliance, Time Required for Diagnosis and Pain of Patients with Finger Tendon Injury Between Gross and Ultrasonographic Confirmation: Seo Woo Lee, Hyun Jae Park, Jung Won Lee, Sae Hoon Park, Jae Woo Kim; J Korean Soc Traumatol. 2010;23(2):83-88.

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Abstract PDF: PURPOSE
It is not always easy to determine the existence of tendon injuries when it comes to patients with finger lacerations. Thus, we tried to find the difference in effectiveness and in compliance of patients when we employed two different types of diagnosis, conventional gross confirmation and ultrasonographic confirmation.
METHODS
From December 2009 to March 2010, we enrolled 14 patients with finger tendon injury at Soonchunhyang University Cheonan Hospital. The median age of the patients was 35.9+/-14.4, and the ratio of females to males was 1:2.5 We evaluated the compliance of each patient by measuring four different categories (level of cooperativeness in showing their wound and in following the instructions, level of movement of their fingers during the diagnosis and total number of attempts to diagnose) by using a score from 1 to 3 for each category, for a total possible score of 12 for each patient. We also measured the painfulness of each patient by using a score of 1 to 10 and the time required for each diagnosis.
RESULTS
The levels of patients' compliance was 8.9+/-2.1 when diagnosed with gross confirmation and 9.8+/-2.1 when diagnosed with ultrasonographic confirmation (p value=0.042). The pain score of the patients was 3.7+/-1.7 with gross confirmation and 2.9+/-1.2 with ultrasonographic confirmation (p value=0.020). The median duration of time in each test was 6.7+/-4.8 minutes with gross confirmation and 10.5+/-4.2 minutes with ultrasonography (p value=0.006).
CONCLUSION
Comparing gross confirmation and ultrasonographic confirmation, gross confirmation is a better method than ultrasonography because of time efficiency. However, ultrasonographic confirmation has advantages over gross confirmation in pain scale and better compliance of patients. Emergency physicians generally employ gross confirmation rather than ultrasonography in determining the existence of tendon injury in patients. In patients with finger lacerations without bone injury, ultrasonography can be considered as a secondary diagnostic tool, especially when patients have much pain.; Summary

The Utility of Ultrasonography in the Emergency Department for the Diagnosis of Finger Tendon Injury: Jung Woo Park, Jang Young Lee, Won Suck Lee, Won Young Sung, Sang Won Seo, Jung Il Yang; J Trauma Inj. 2014;27(4):139-144.

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Abstract PDF: PURPOSE
Detection and determination of tendon injury in the finger or hand is not easy. Therefore, we aimed to study and evaluate the accuracy and the effectiveness of ultrasonography for the diagnosis of finger tendon injury.
METHODS
In this study, we enrolled patients, regardless of age and sex, with lacerations on their fingers. Patients with invisible wounds were excluded. We evaluated the accuracy and the effectiveness of ultrasonography and compared the results obtained from ultrasonography and with those obtained by visual observation of the injuries.
RESULTS
The sensitivity, the specificity and the accuracy of ultrasonography were found to be 66.7%, 100% and 91.3%, respectively (p<0.001) while those of physical examination were 71.4%, 98.3% and 91.3%, respectively. Small differences were observed between the sensitivities and specificities of the two examinations; however, the accuracies were the same (p<0.001). The area under the receiver operating characteristic (ROC) curve, which was used for diagnosis of tendon rupture using ultrasonography, was found to be 0.985 (95% confidence interval CI: 0.929-0.999),while that of physical examination was 0.938 (95% CI: 0.861-0.980).
CONCLUSION
Ultrasonography can be used an effective diagnostic tool for patients with finger tendon injury.; Summary

Optimal Insertion Angle between the Skin and Needle in Ultrasound-Guided Internal Jugular Vein Catheterization with Trauma Patients: Hyun Min Jeon, Sung Min Jung, Ru Bi Jung, Jin Jeon, Chong Kun Hong, Tae Yong Shin, Young Rock Ha, Young Sik Kim; J Trauma Inj. 2013;26(3):183-189.

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Abstract PDF: PURPOSE
The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients.
METHODS
From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV's anterior-posterior (AP) vessel wall on the longitudinal scan's midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV's internal center on screen's midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 cmH2O, 5< or = middle CVP < or =10 cmH2O, and high CVP>10 cmH2O) and compared their mean anterior posterior (AP) diameters and optimal angles.
RESULTS
A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups(0.68+/-0.30, 1.06+/-0.31, and 1.23+/-0.49 cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups' mean optimal angles (28.1+/-6.1, 30.1+/-4.5, and 28.0+/-5.0 degree respectively).
CONCLUSION
The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV's diameter is altered in proportion to the CVP.; Summary

Availability of the Optic Nerve Sheath Diameter Measured by Using Ultrasonography as a Secondary Survey for Patient with Head Injuries in the Emergency Department: Dong Wook Lee, Jung Won Lee, Sae Hoon Park, Ihl Sung Park, Hyun Jung Lee, Byeong Dae Yoo, Hyung Jun Moon; J Trauma Inj. 2013;26(3):104-110.

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Abstract PDF: PURPOSE
Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED).
METHODS
From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS.
RESULTS
A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was 5.98+/-0.59 mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was 4.63+/-0.21 mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve).
CONCLUSION
An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.; Summary

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