Impact of early FAST ultrasound on severe trauma outcomes: a randomized trial in a low-resource African emergency...

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Diagnostic Imaging

Background:

• Trauma is a major global cause of death, particularly in low- and middle-income countries (LMICs).
• Limited diagnostic resources in LMICs pose challenges for effective trauma patient management.
• The Focused Assessment with Sonography for Trauma (FAST) is a potential tool to improve trauma care in resource-limited environments.

Purpose of the Study:

• To evaluate the impact of early Focused Assessment with Sonography for Trauma (FAST) on mortality in polytrauma patients.
• To assess the effect of FAST on resource utilization, including CT scans and time to surgery.
• To determine the effectiveness of FAST in a low-resource trauma care setting.

Main Methods:

• A single-center randomized controlled trial was conducted in Morocco involving adult severe trauma patients.
• Patients were randomized to receive either standard care or a protocol including FAST during initial triage.
• Primary outcome was in-hospital mortality; secondary outcomes included 30-day mortality, time to surgery, CT use, transfusion needs, and hospital stay.

Main Results:

• The FAST group showed significantly lower in-hospital mortality (39.2% vs. 66.2%, p=0.001) and 30-day mortality (45.6% vs. 72.7%, p=0.001).
• FAST use was associated with reduced odds of in-hospital death (aOR 0.48) and improved survival time (HR 0.56).
• The FAST group had decreased CT use (82.5% vs. 96.1%) and shorter time to surgery (5.16 vs. 9.82 hours).

Conclusions:

• Early implementation of FAST in trauma triage significantly reduces mortality.
• FAST integration leads to decreased use of CT scans and shorter surgical delays.
• These findings support the incorporation of FAST into trauma care guidelines, especially in LMICs.