Is a Positive Prehospital FAST Associated with Severe Bleeding? A Multicenter Retrospective Study

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Point-of-Care Ultrasound

Background:

• Severe hemorrhage is a leading cause of preventable death in trauma patients.
• Early diagnosis and prediction of severe hemorrhage are critical for improving patient outcomes.
• Prehospital assessment plays a vital role in the initial management of trauma patients.

Purpose of the Study:

• To investigate the association between positive findings on prehospital sonography for trauma (FAST) and the occurrence of severe posttraumatic hemorrhage.
• To evaluate the predictive performance of FAST in identifying patients with severe hemorrhage.

Main Methods:

• Retrospective analysis of thoracic or abdominal trauma patients managed in French mobile intensive care units (2017-2021).
• Severe hemorrhage defined as requiring ≥4 packed red blood cell transfusions or hemostatic intervention within 24 hours.
• Multivariate analysis used to assess the predictive value of FAST, alone and with Red Flags criteria.

Main Results:

• Of 527 patients, 73 (14%) experienced severe hemorrhage.
• A positive FAST was detected in 38% of patients with severe hemorrhage versus 13% without (p < 0.01).
• Positive FAST was associated with increased need for hemostatic procedures, ICU admission, longer hospital stays, and higher 30-day mortality.

Conclusions:

• Prehospital FAST is associated with severe hemorrhage in trauma patients.
• A positive FAST scan in the prehospital setting is a significant predictor of severe hemorrhage and adverse prognostic outcomes.
• FAST can aid in the early identification of trauma patients requiring urgent intervention.