• Trauma
• Ultrasonography

• Emergency Medicine
• Trauma
• Ultrasonography

In the decades since the Focused Assessment with Sonography in Trauma examination was first proposed, the use of point-of-care ultrasonography has expanded further into the trauma world. Matt Dawson, MD, University of Kentucky, Lexington, Kentucky, USA, discussed the modern use of bedside ultrasonography in the initial evaluation of trauma patients.

Bedside ultrasonography has been shown to be equal to or more sensitive than other modalities for detecting traumatic injuries. In a randomized controlled clinical trial, patients presenting to the emergency department with suspected torso damage assessed with ultrasonography had considerably decreased time to operative care, improved resource use, and lower medical costs [Melniker LA et al. Ann Emerg Med. 2006]. A more recent study reported that bedside ultrasonography had higher sensitivity and similar specificity compared with chest radiography for the diagnosis of pneumothorax [Ding W et al. Chest. 2011].

Point-of-care ultrasonography has long been used for the assessment of hemoperitoneum and hemopericardium in emergency departments and operating rooms [Rippey JC, Royse AG. Best Pract Res Clin Anaesthesiol. 2009]. Ultrasonography can also be used to assess vascular injuries, musculoskeletal injuries, genitourinary injuries, and fetal viability in pregnant trauma patients. In addition, ultrasonography can be used to guide nerve blocks and vascular access in real time.

Another application that may be useful in the setting of trauma is the tracheal rapid ultrasound examination [Chou HC et al. Resuscitation. 2011]. Correct positioning of an endotracheal tube can be confirmed by a sonographer within 3 seconds of placement, with 100% sensitivity and specificity [Muslu B et al. J Ultrasound Med. 2011].

Another useful application of ultrasonography is as a noninvasive test for elevated intracranial pressure (ICP). Optic nerve sheath diameter > 5 mm as detected by ocular ultrasonography identifies patients with ICP > 20 cm H₂O and has been highly correlated with ventriculostomy measurements [Kimberly HH et al. Acad Emerg Med. 2008]. Third-ventricle midline shift as evaluated by transcranial color-coded sonography is more sensitive and specific than the pulsatility index in detecting large intracerebral hemorrhage and it is also a significant predictor of short-term functional outcome (OR, 2.09; 95% CI, 1.06 to 4.13) [Tang SC et al. J Ultrasound Med. 2006].

Point-of-care ultrasonography is particularly useful in settings in which traditional radiography is unavailable or undesired. Clavicle fracture, a common orthopedic injury in children, can be diagnosed with bedside ultrasonography with 95% sensitivity, 96% specificity, and 96% overall accuracy [Cross KP et al. Acad Emerg Med. 2010]. Even in the hands of physicians with minimal training, portable ultrasonography is useful for detecting fractures in a remote setting [Marshburn TH et al. J Trauma. 2004].

Ultrasonography has long been the standard for hemodynamically unstable patients with concerning mechanism of injury. However, ultrasonography is also being use to assess and to follow-up on stable patients with blunt abdominal trauma concern for solid organ (liver, spleen, kidneys) damage, particularly in low-energy injuries [Afag A et al. Eur J Emerg Med. 2012].

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