Impact of Point-of-Care Ultrasound in Triage on Diagnosis and Treatment of Trauma Patients in a Resource-Limited Setting in East Africa

Abstract

BACKGROUND Emergency Department Point-of-Care Ultrasound (ED-POCUS) has shown promise in expediting the management of patients in resource-limited settings. This study aimed to evaluate the clinical impact of triage-based ED-POCUS using the Extended Focused Assessment with Sonography for Trauma (E-FAST) exam for the evaluation of blunt trauma patients in the Accident & Emergency Department (A&E) of a large tertiary public hospital in East Africa.

METHODS This was a non-randomized, prospective, quasi-experimental study of adult patients presenting with blunt torso trauma to the A&E of Kenyatta National Hospital in Nairobi, Kenya. The before group received usual care, and the intervention group underwent an E-FAST exam immediately after triage in addition to usual care. The primary outcome was defined as the occurrence of and time to intervention, such as transfusion of blood products, chest tube insertion, or transfer to the operating theatre. Secondary outcomes included time to intravenous fluids (IVF), first speciality consultation, time from consult to specialist evaluation, disposition, length of hospital stay, and in-hospital mortality.

RESULTS The usual care group (before ultrasound) included 149 patients, and 99 patients were enrolled in the E-FAST (after ultrasound) cohort. The occurrence of and time to the composite primary outcome did not differ significantly between the two groups (p=0.61 and p=0.56, respectively). Of the secondary outcomes, time to IVF was significantly shorter in the E-FAST compared with the usual care group (median 5.5 minutes (IQR 16.0) vs 32.8 (117.5).

CONCLUSION The use of the E-FAST exam at triage in blunt trauma victims did not significantly improve the time to surgical intervention or transfusion of blood products. However, there was improved time to IVF resuscitation.