Trauma-Informed Care in Emergency Ultrasound (TIES): A prospective matched patient-clinician survey study

Point-of-care ultrasound (POCUS) is widely used in emergency departments (EDs) but often requires close patient contact and body exposure, which may increase patient vulnerability. Trauma-informed care (TIC) principles have not been formally studied in the context of POCUS. This study aimed to evaluate and compare patient and clinician perspectives on TIC behaviors during ED POCUS.

We conducted a cross-sectional study at two urban academic EDs using matched patient-clinician surveys. The Trauma-Informed Emergency Sonography (TIES) survey was developed following a seven-step framework, including literature review, expert content validation, cognitive interviews, and pilot testing. The survey assessed behaviors across the six core TIC domains using 5-point Likert-scale items. Patients completed 26 experience-related items and clinicians completed 29 behavior-related items following each POCUS encounter. Responses were summarized as percent agreement and compared between matched pairs using Wilcoxon signed-rank tests.

Among 143 matched patient-clinician pairs, patients consistently reported higher agreement with TIC practices than clinicians reported performing. The largest differences were in informing patients they could stop the exam (77% patients vs 45% clinicians, p < 0.001), asking about companion preferences (78% vs 48%, p < 0.001), and allowing time to redress before discussing results (87% vs 56%, p < 0.001). Significant differences were observed in four of six TIC domains: empowerment, voice, and choice (p = 0.001); peer support (p < 0.001); trustworthiness and transparency (p = 0.024); and collaboration and mutuality (p = 0.035). Clinicians with prior TIC training and advanced practice providers demonstrated stronger alignment with TIC behaviors.

Patients perceived their POCUS experience as more trauma-informed than clinicians recognized in their own practice, with the largest differences in communication, consent, and eliciting patient preferences. The TIES survey may serve as an exploratory tool to assess TIC behaviors during ED POCUS encounters and inform future training efforts.